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If people knew how much food they threw away each week, would they change their food-wasting ways? That's a question scientists explore in the 2023 State of Food Waste in America report. The research goal was to understand why and how households waste food, and what would motivate them to prevent food waste. In today's podcast, we'll talk with MITRE scientists Laura Leets and Grace Mika, members of a team who developed and launched the MITRE Food Waste Tracker app. This is a first of its kind app for households to log information about discarded food and learn ways to save money by reducing food waste. The Food Waste in America study team includes the Gallup Survey Company, researchers from the Ohio State University, the Harvard Law and Policy Clinic, ReFED, the Natural Resources Defense Council, and the World Wildlife Fund. Interview Summary   Laura, let's begin with you. Can you give us a quick overview of why MITRE focused on measuring food waste at the household level and the behaviors? Laura - In a general sense, Norbert, we know the United States waste 30 to 40% of our food, yet we do not know how much is wasted at the household level. We know that waste occurs along the entire farm to table supply chain, like approximately 15% with farms, 15% at manufacturing, about 20% at stores and restaurants and about 50% in the household. So, given that half the waste happens at the household level, it's important to measure it. If you can measure it, you can do something about it. Up to this point, people have not had an easy way to estimate their amount of food waste. So, to address this gap, not only did we develop a new way to measure household food waste and Grace will share more about that, but we also provided a baseline measurement of American household food waste. I would like to really dig in a little bit more. How much food do American households waste, and do you have a sense of what kinds of foods people are wasting? Laura - Let me start with the amount first. We found that the average American household wastes somewhere from 3 to 4.5 pounds per week. And there's two ways to measure household food waste. The first is you can focus on the edible or uneaten food. And with this measure, American households waste about on average three pounds per week. Second, you can add inedible food. So, that's your food scraps, your eggshells. And if you take edible plus inedible food together, then the American households wastes on average about 4.5 pounds per week. Let me give your listeners a couple analogies to understand that impact of that 3 to 4.5 pounds of household food waste. So, let's say we combine our own household food waste with everyone else's. The crop waste is large enough to cover the states of California and New York. From a personal perspective, imagine before every meal you scrape off 40% of the food on your plate. If you imagine that in each meal, you're going to start to understand that the current food waste is massive, and we're all contributing to it. So that's the measurement piece. I'm going to pass it over to Grace to discuss the types of food we're wasting. Grace - Americans are wasting a wide variety of foods in their homes, but the number one wasted food type is your fresh produce. So, that would be your fruits and your vegetables. I think this is really important to keep in mind, not only because, of course, fruits and vegetables are perishable, but when we think about healthy diets, many people in the nutrition space are encouraging fresh fruits and vegetables or fruits and vegetables in general. Ao this is a really important finding, and I'm excited to know this. But it's also important for our listeners to think a little bit more about this. Grace, I would like to learn a little bit more from you. Can you tell us more about the MITRE Food Waste Tracker, the app itself? Grace - I would be happy to. The MITRE Food Waste Tracker app is meant to be a tool for households who want to understand exactly what's going uneaten in their home. If you had asked me what exactly I ate yesterday and how much of that went into my trash can, I would have a really difficult time remembering an answer to that question. And that's for just yesterday, let alone multiple days or weeks ago. Not knowing what exactly goes uneaten would make it really challenging for me to cut back on that waste. So, to solve that problem, our team designed an app which allows for food waste to be logged in real-time. So, right as you're doing your meal prep or you're clearing off the dinner dishes or emptying your leftovers out from the fridge. And the app tracks details both about the food itself, like where you got that from and the food group that it belongs to, as well as where, why, and how the food was thrown away.   And you can also track how much waste was produced, and we encourage you to use your hand as a guide to estimate the volume of that waste. So, your closed fist is about the size of a cup of food and your thumb about the size of a tablespoon. The more that you use the app to track, the more you will reveal patterns in the way that you waste. Maybe you find out that you're optimistically shopping for vegetables that your toddlers at home are just not interested in eating. Or maybe you're serving up heaping platefuls at dinner time, but then find that you're not hungry to finish that meal. So learning this will empower you to make small changes in the way that you shop for, prepare and store food to make sure that as little as possible is going to waste.   And if you're money-minded like many Americans are, you might be especially interested in an app feature which estimates the cost savings that you would experience if you cut back on your waste. So less food in the trash means more money in your wallet and the savings really add up. The average American family spends over $1,500 on wasted food each year. And tracking with the app is fast and simple. For each food that you dispose, you would simply click on the icons that best describe your waste. It would be really easy to get the whole family, even your your kids involved in tracking and thinking about the food that's going into the bin. You've already touched on a few of these key findings about sort of the top foods that we end up wasting. Are there other findings that you would like to share with us? Grace - So there are two behaviors that really stood out when it came to producing food waste. The first is simply being willing to eat your leftovers. Personally, I get really excited about leftover nights. It means I get a good home cooked meal with almost no prep work that evening. A lot of us are already doing this. About a third of Americans incorporate leftovers into new dishes and about half of us frequently eat leftovers just as a meal by themselves. Those leftovers add up. We found that households who consistently throw their leftovers away are wasting nearly four times as much as households that eat those up. We also found that households' understanding of and behavior around date labels plays a significant role in their levels of waste. A lot of us don't really understand how little date labels actually mean, and how little they're standardized. Not too long ago I was cooking with a friend, and we were making dinner together and he smelled a bag of shredded cheese and he said, "Oh, this smells kind of funky, but it's not past his date." And he added it into the dish. You should actually be doing the exact opposite of that. You should trust your senses over the date label when it seems that something is spoiling. There are some dates that are meant to be safety indications, but the majority are just a manufacturer's best guess of when food will pass its peak quality. And frequently, thrown away past date food that has no signs of spoilage so this leads to wasting over twice as much food. It can be easy to feel helpless when it comes to wasting food, but it's surprisingly simple to take control over your waste As we mentioned before, if you're curious about what sorts of behaviors are leading to waste in your own home, we have an app for that. So, our latest version of the app has new features to help you understand your waste and even get a sense of how much money you could be saving if you cut back on your waste in your home. I highly encourage you to check that out. I've got to say I have done some work on date labels and have found this is an important area of consideration. But also, one where the modification of those date labels may actually help reduce food waste. I'm so happy to hear you talk about the sort of broader set of things that consumers can do to actually mitigate food waste in the household. You got into some of my own personal family issues around what do we do about leftovers, and I will not report this conversation to my family. So, thank you for that, Grace. Laura, I want to go back to you and ask about a big picture question. Why should our listeners reduce their household food waste? Laura - Norbert, I believe I can make a compelling case for that. This is a rare opportunity when making a small change can have a large positive impact. Let me explain the amazing cascading ripple effect that happens when we reduce our household food waste. We had Grace reminding us with the app, and the first benefit is financial. An average American household can save at least $1,500 a year or $125 a month by reducing food waste. So just focus on that personal financial benefit, and then understand the resulting ripple effects. That first ripple effect is going to impact the ecology. Most of us don't realize significant resources go into producing food. The USDA reminds us that 50% of our land in America is used for food production and 80% of our water is used to produce that food. When we reduce our food waste, we're recognizing food as this precious resource, and we are supporting our food production industry. This is really important because America is one of the top food producers in the world.   The next ripple effect impacts food security. Food security is part of national security. When you reduce your household food waste, you are also supporting national security. Next is a societal impact. Reducing food waste allows us to optimize our food and feed more people. And, finally, there is a significant environmental benefit. The number one substance going into our landfills is food waste. As it decomposes, it emits greenhouse gases that cause this pollution blanket to surround the planet. That pollution blanket traps heat and warms the planet. So, when we reduce our food waste, it's one of the top three activities we can do to reduce warming temperatures and extreme weather events. We all have the ability to combat climate change through our household food waste. These small changes in our food waste - they're going to result in positive financial, societal, and environmental benefits. It's such a powerful, impactful decision to reassess your food waste and think about ways you can reduce it.   Bios Dr. Laura Leets is an accomplished researcher, teacher, and mentor. She brings 30 years of experience from academic and industry environments.  She currently serves as an innovation lead and senior principal scientist at MITRE. In this leadership capacity, she works with researchers to identify, shape and conduct important, transformative, and impactful projects for government sponsors and the nation. She also serves as an adjunct professor at Georgetown University's Communication, Culture, and Technology Program and previously spent a decade as a Professor of Communication at Stanford University.  She has been recognized with several top paper and teaching awards throughout her academic career.    Grace Mika, B.S., is a data scientist in MITRE's Modeling & Analysis Innovation Center, where she has worked on projects for the Center of Disease Control, Internal Revenue Service, Veterans Benefits Association, and the Office of the Undersecretary of Defense, Acquisitions & Sustainment. She is passionate about visualizing data in a clear, accurate, and accessible way. Grace was instrumental in the design of a first-of-its-kind Food Waste Tracker App, which allows users to track waste as it occurs within their homes. Grace holds a B.S. in Applied Math and Psychology from the College of William & Mary and is currently working towards her Masters of Analytics at Georgia Institute of Technology.

In August of 2023, the Food and Drug Administration issued something known as a direct final rule, disregarded trans fats in the food supply. Consumers won't notice changes as the rule just finalizes FDA's 2015 ruling that partially hydrogenated oils - trans fats - no longer had "GRAS status." GRAS stands for generally regarded as safe. We cover this issue today because this trans fat ban was the product of lots of work by a key group of scientists, the advocacy community, and others. The anatomy of this process can teach us a lot about harnessing scientific discovery for social and policy change. At the center of all this is today's guest, Dr. Walter Willett. Willett is one of the world's leading nutrition researchers. He is professor of epidemiology and nutrition at the Harvard T.H. Chan School of Public Health, and for many years served as chair of its Department of Nutrition. He's published extensively, been elected to the National Academy of Medicine, and it turns out, is the world's most cited nutrition researcher. Interview Summary   There are so many things I could talk to you about because you do work in such an array of really important areas and have just made contribution after contribution for years. But let's talk about the trans fat because you were there at the very beginning, and it ended up with a profound public policy ruling that has major implications for the health of the country. I'd like to talk about how this all occurred. So, tell us, if you would, what are trans fats, how present were they in the food supply over the years, and what early discoveries did you and others make that led you to be concerned?   Yes, this is a story from which I've learned a lot, and hopefully others might as well. Trans fats are produced by the process called partial hydrogenation. This takes liquid vegetable oils, like soybean oils, corn oil, canola oil, and subjects them to a process with high heat and bubbling hydrogen through the oil. What this is doing is taking essential molecules, essential fatty acids like the omega-6 and omega-3 fatty acids and twisting their shapes just subtly, and this turns them into a solid fat instead of a liquid fat. And, of course, the food industry likes this because our culture, the Northern European eating culture, emphasizes solid fats like butter and lard. Industry really didn't know what to do with all the liquid oil that they were able to produce by another process that was discovered back in the late 1800s. The partial hydrogenation process was actually developed in about 1908, and someone actually got a Nobel Prize for that. It wasn't used widely in the food industry till the 1930s and 1940s when it was upscaled because it was cheaper, for multiple reasons, to partially hydrogenate oils and turn them into solid fats like Cricso and margarines. I got worried about this, actually, back in the 1970s, when other scientists were discovering that these essential fatty acids are important for many biological processes, clotting, arrhythmias, inflammation, and counteracting inflammation. I realized while studying food science at that time that there was nobody really keeping an eye on this. That there were these synthetic fatty acids in massive amounts in our food supplies. Margarines, vegetable shortenings were up to 30% and 40% made of trans fatty acids. And that may me concerned that this could have a big downside. So, back in 1980, with the help of some people at the Department of Agriculture developing a database for trans fats in foods, we began collecting data on trans fat intake in our large cohort studies. And about 20 years later, we saw that trans fat intake was related to risk of heart disease. We published that in 1993. That got us started on the pathway to getting them out of our food supply.   Let's talk about how present they were in the food supply. You mentioned some things like margarine and Crisco, but these fats were in a lot of different products, weren't they?   Yes, they were almost everywhere. You could hardly pick up a product that had a nutrition facts label that didn't say partially hydrogenated fat on it. It was really in virtually everything that was industrially made in our food system.   Just because they could produce them at low cost? Or did they have other properties that were desirable from the industry's point of view?   These trans fats had multiple characteristics. One, they could be solid. And again, because they mimicked butter and lard, it fit into lots of foods. Second, they had very long shelf life. Third, you could heat them up and use them for deep frying, and they could sit there in fryolators for days and not be changed. So, this was all good for the food system. It wanted really long shelf life and started with cheap ingredients.   So, after those initial findings that raised red flags, what kind of research did you do subsequently and at what level of proof did you feel policy change might be warranted?   Within our own group, we continued to follow our participants. These are close to 100,000 women in the Nurses' Health Study, and also another 50,000 in the health professionals follow up study. We confirmed our initial findings and then found that trans fats were related to risk of many other conditions, from diabetes to infertility. And simultaneous with our work in the 1990s, some of our colleagues in the Netherlands were doing what we called controlled feeding studies. These studies take a few dozen people and feed them high trans fat or low trans fat for a few weeks and watch what happens to risk factors like cholesterol levels and triglyceride levels. And they found that trans fats had uniquely adverse consequences. They raised the bad cholesterol, LDL cholesterol, and reduced the good cholesterol, HDL cholesterol. So, they had unique adverse biological effects. It was really that combination of that short-term kind of study and the long-term epidemiologic studies we were doing that made a compelling case that trans fats were the cause of cardiovascular disease.   So, a line of considerable work took place over a number of years, and then got to that point where you felt something needed to be done. And the fact that you did that science and that you were worried about these trans fats in the first place is impressive because you were really onto something important. But what happened after you did the series of studies? What steps occurred and who were the key actors that finally led to policy change occurring?   Well, as we expected, there was pushback from the industry about this because they were so invested in trans fat. And I was actually disappointed that a lot of our colleagues in the American Heart Association and others pushed back as well. They didn't want to distract from saturated fat. But, when studies were reproduced, it was really undeniable that there was a problem. But, if the studies had just been put on a shelf and sitting there, probably nothing would've happened. And it was really important that we partnered with advocacy groups, particularly Mike Jacobson, Margo Wootan at the Center for Science in the Public Interest, because they had a readership and audience that we didn't have. And they also were more familiar with the workings of the Food and Drug Administration and government in general. But I also was told somewhere around that time that women, who are the main food purchases, pay most attention to a lot of the women's journals, Family Circle, those kinds of journals. And actually, for good reasons. Their journalists are very good. So, I've talked to those journalists every opportunity. And it turned out it was really important to have some public awareness about this problem. If it was just good science and things worked as they should have, the FDA would've looked at the evidence and just ruled out trans fat from our food supply early on, but they didn't. It really took major concerted effort by the combination of the scientific community and the advocacy group.   Did you bump into conflict of interest problems with other scientists who were receiving funding from the industry and you know them talking to the press or speaking at conferences or things like that?   Well, there's plenty of conflicts of interest within the nutrition community, but actually, I don't think that was so much of an problem here. In some ways, there was a conflict of sort of personal commitment to entirely focusing on saturated fat and not wanting to see any distraction. I don't think a conflict of interest in the economic monetary sense.   Walter, I remember back when this discussion was occurring and industry was fighting back. They made claims that food prices would go up, that the quality of foods would go down, that it would be a real hit to their business because consumers wouldn't like products without the trans fats. What became of all those arguments?   It's interesting and it's important to keep in mind that the industry is not monolithic. And I have to credit Unilever, actually, with paying attention to the scientific evidence, which was really rejected here. Interestingly, at that time, all the major margarine manufacturers were owned by the tobacco industry. And you can imagine that those CEOs were not getting out of their bed in the morning and saying, well, what can I do to make Americans healthier? No, they were not interested in health. But Unilever was a food company and it was invested in staying as a food company for the continuing future. And they did realize that this was a problem, and they invested a lot of money to re-engineer their products, re-engineer their production of margarine and shortening. And they did take trans fat out of their products. They obviously did a lot of taste testing to make sure they were acceptable. And once they did that, the industry could no longer say that it's impossible to do it. It's sort of like the automobile industry when Detroit said, you just can't build low pollution cars, but then the Japanese did it and then they could no longer deny it.   Boy, it's such an interesting story that occurred. With Unilever getting involved as they did. That must have been a very positive push forward. They're second biggest food company in the world.   That was really helpful. And again, I think it was because they had a lot of scientists, both nutritionists and food chemists. I was told they had about 800 such employees at that time. They could see, if you looked at the evidence honestly, this was a serious issue. One of their chief scientists later told me that it was actually one of our editorials in the American Journal of Public Health where we estimated that there would be about 80,000 premature deaths per year due to trans fat. And once they saw that, they said, we can't have Willett going around saying there's going to be 80,000 premature deaths, and they realized they had to do something. It's interesting, you write an editorial, you don't know who's going to read it, but sometimes it hits one person who can really make a difference.   It is nice to know that people read things like that once in a while. Let's go to where you were at that point. You produced a lot of science. You were communicating this to professional audiences, but also to the general public with interviews and magazines and things like that. And the advocacy community, especially the Center for Science in the Public Interest, got activated. What happened then?   Well, a couple things happened. One is that they brought up and proposed labeling trans fat on the nutrition facts label and submitted that to the FDA. The FDA sat on it. There was, of course, lots of backdoor action by the American food industry that did not want to change what they were doing. And despite some prodding by CSPI over the years, that sat there for about 10 years almost. Ironically, there was a faculty member at Harvard Chan School of Public Health at that time who had seen a display we had done on trans fat. We built a big tower out of blocks of trans fat and had a little poster there talking about it. He went to Washington and became a senior person at the Office for Management and Budget. And Mike Jacobson went to go visit him with a petition to label trans fat, and our faculty person said, I know about trans fat because Willnett had that display in our cafeteria. He wrote a letter to the FDA that was quite unprecedented, basically saying that either put trans fat on the food label or tell us why not. Which is a quite strong letter. And then the wheels started turning, and there was delay and delay for a pushback on the food industry. But by 2008, trans fat actually did get on the food label. And that had a very major impact, because once it had to be on the label, the food industry took it out. They sort of knew it was coming because they didn't want to admit it publicly. But I think they understood for quite a while that they were going to have to get it out, but that was really the turning point. All of a sudden, almost all the food products had zero on the trans fat line there.   Let's talk about the public health impact of this. You mentioned 80,000 or some deaths occurring each year attributable to consumption of trans fat. Can we conclude from that that we're saving that many lives now with trans fat out of the food supply? And does that mean 80,000 lives year after year after year?   It's hard to know exactly and of course, so many things are going on at the same time. And the trans fat didn't go down abruptly because Unilever was, even in the American market, a pretty major producer, starting by the mid 1990s, trans fat intake actually did start to go down. And other things are going on, obviously obesity epidemic counterbalancing a lot of positive things that were happening. But, there were some economists looking at communities that adopted trans fat bans early on versus those that did not, and they could show there was a divergence in heart attacks and hospitalizations for heart disease. So it's hard to pin an exact number on it, again, because all these things happen at the same time. But it's quite clear that we would be having quite a bit more heart disease if trans fat had not been eliminated. I would also look back to another important step in the process because even though we got trans fat on the food label, and the products that had it quite quickly became, almost all of them, zero trans fat, but that didn't deal with a restaurant industry, which was also a very big source of trans fat. And there it took community activists to make this happen. There was a small community in Northern California that was really the first community that banned trans fat in restaurants, and a few other places did. But then Mayor Bloomberg of New York, there's another backstory why he got interested in this. But it's one of these things, you put out information and you don't know who's going to read it, and someone had read some of our work and to convince his health department and Bloomberg himself that trans fats had to go, and New York banned trans fats. And then some other communities, Massachusetts and elsewhere in the food industry, the restaurant industry realized they couldn't have a patchwork distribution system. And so that was a tipping point that trans fat was eliminated in the food service industry long before the FDA finally made the ruling. In fact, by the time the FDA made the ruling about trans fat and pressure hydrogenated fat, it was almost gone.   To go back and look at the history of this, it's a relatively small number of key people taking the right actions at the right time that ultimately led to change. And thank goodness for those people like you and Mike Jacobson, Margo Wootan, and Mayor Bloomberg, and a few other people in political circles that took the bull by the horns and really got something done. Very impressive. As you look back on this, what lessons did you learn that you think might be helpful for future policy changes?   I think there are a number of lessons. I'd like to think, first of all, that solid good science is really important. Without that, we couldn't have a hard time making changes that we need to do. But that's usually not going to be enough. It's really important to work with advocacy groups like CSPI. It's important, sometimes, to work with journalists and provide good information, education. But it's hard to know exactly which path is going to be successful. One thing is quite clear, in this country, in many areas, change does not happen from the top. It's not enough just to have good science. And oftentimes, changes happen from the bottom up at the local level, the state level, and the national government may be the last place where action occurs.   So what changes in the food supply do you feel would be most pressing right now?   We certainly have a lot of problems in our food supply. If you look around, most people are consuming diets and beverages that are quite unhealthy. And there are so many issues, I think, still and we've worked on this issue is a sugar sweetened beverage issue, and we've had some real progress in that area, but still, there's a huge way to go to reduce sugar sweetened beverages. But that's part of a bigger problem in terms of what we're consuming. And I would call that carbohydrate quality, that about half of our calories come from carbohydrates. In about 80% of that half, in other words, about 40%, of all the calories we consume are refined starch, sugar, and potatoes which have adverse metabolic effects, lead to weight gain, lead to diabetes, lead to cardiovascular disease. So that's a huge area that we need to work on.   You've talked, so far, with the trans fat and, you know, and with other things in the food supply like salt, these are things that you'd be taking out of the food. That all makes good sense. What about putting things in? Talk about things that might support the microbiome, more fiber, or things that might support brain health and things like that, so what are your feeling about those things?   You're right, our problems are both what's there in quantities that are unhealthy and also what's missing. Inadequate fiber intake is actually part of the carbohydrate problem. Clearly, we should be consuming many more whole grains compared to the amount of refined grains that we consume. And, of course, we get some fiber from fruits and vegetables. So I think, in addition to this huge amount of unhealthy carbohydrates and inadequate amount of whole grains, we do need to be consuming more fruits and vegetables. And then on the sort of protein source side, we're clearly consuming too much red meat and replacing that with plant protein sources like nuts, legumes, and soy products would be really important for direct human health. But also, that's an area where the environmental and climate change issues are extremely pressing and shifting from a more animal-centric diet to more plant-centric diet would have enormous benefits for climate change as well as direct effects for human health.   Bio   Walter C. Willett, M.D., Dr. P.H., is Professor of Epidemiology and Nutrition at Harvard T.H. Chan School of Public Health. Dr. Willett studied food science at Michigan State University, and graduated from the University of Michigan Medical School before obtaining a Masters and Doctorate in Public Health from Harvard T.H. Chan School of Public Health. Dr. Willett has focused much of his work over the last 40 years on the development and evaluation of methods, using both questionnaire and biochemical approaches, to study the effects of diet on the occurrence of major diseases. He has applied these methods starting in 1980 in the Nurses' Health Studies I and II and the Health Professionals Follow-up Study. Together, these cohorts that include nearly 300,000 men and women with repeated dietary assessments, are providing the most detailed information on the long-term health consequences of food choices. Dr. Willett has published over 2,000 original research papers and reviews, primarily on lifestyle risk factors for heart disease, cancer, and other conditions and has written the textbook, Nutritional Epidemiology, published by Oxford University Press, now in its third edition. He also has written four books for the general public. Dr. Willett is the most cited nutritionist internationally. He is a member of the National Academy of Medicine of the National Academy of Sciences and the recipient of many national and international awards for his research.  

With record-breaking food prices in 2022, it has become more expensive for families to buy the foods that they need. The Supplemental Nutrition Assistance Program, or SNAP, helps families purchase foods but families frequently spend their benefits before the next benefit cycle. USDA modifies SNAP benefits every year as a cost-of-living adjustment. But was the change in fiscal year 2023 enough to keep pace with food price inflation? Today, we talk with Elaine Waxman from the Urban Institute to find out. Interview Summary   You recently completed an analysis on the gap between SNAP benefits and the real cost of a meal. Can you tell us what you found?   Absolutely. I think it helps to start with the fact that for many households, SNAP is a supplement to their budget that they would spend on food. But for about four in 10 households, it is their food budget. In other words, they're deemed to have zero income available to purchase food. What we've done is look at how adequate is the benefit for those households, the ones that receive the maximum benefit. Given overall questions about SNAP adequacy, but because there's such wide variation in geographic food prices, something that I think we all know intuitively based on our everyday lives but don't realize that, in fact in the lower 48 states, SNAP is not adjusted for any of those differences in food prices. It doesn't matter if you live in rural Texas or rural Idaho or on the Coast, your benefit is the same if you're receiving that maximum benefit. What we find is that particularly, based on those experiences in 2022 that we all felt when we showed up at the cash register, 99% of counties in the US had cost for what we would call a moderately priced meal that exceeded the maximum SNAP benefit when we think about that on a per-meal basis. So that was very concerning obviously because people have been relying very heavily on SNAP throughout the pandemic. For a period, there were extra benefits, what is known as emergency allotments, but those have gone away now. As you mentioned at the start, we do get a yearly cost of living adjustment and it was pretty big last year compared to most years and it did help, but the maximum SNAP benefit did not cover the cost of a meal in 78% of count. So that's an improvement from 99% to 78%. But clearly, in the majority of the US, we're still not really able to fully tap the value of SNAP. And since SNAP is a big part of our strategy for reducing food insecurity, that's something we should all be concerned about.   I think this is really important for listeners to understand. There aren't regional adjustments in the SNAP benefits and there are huge price differences depending on where you are in the US. I know some work out of the Economic Research Service of USDA found that same finding in some earlier years. And so it's really important to see what happens, especially during an inflationary period. Thank you for sharing that. I want to talk about one way that we understand how SNAP benefits are set. And so, USDA updated the Thrifty Food Plan which is the basis of SNAP benefits or at least the maximum benefit level in 2021, and it was the first time since the mid two-2000s. What did that mean for the adequacy of SNAP benefits? And what do we know about how inflation has further affected SNAP benefits?   Yes, great question. It was a very important move on the part of USDA to implement that update to the Thrifty Food Plan, which basically is the market basket of assumptions about food purchasing that USDA relies on to set all SNAP benefits. So it's a critical piece of information. Even though it might sound like inside baseball, to some people, the Thrifty Food Plan really matters. As you noted, it had not been updated since I think 2006. And we all know that not only have prices changed a lot, but the ways in which we acquire food has changed a lot. We buy a lot more prepared foods even to eat at home. A lot more people are working and so the assumption that you can cook everything from scratch doesn't really hold for a lot of households anymore. a number of those assumptions were updated. And for a period, that made a big improvement in that SNAP maximum benefit that we just talked about. Unfortunately, that was eroded by the pretty unprecedented rise in food prices throughout 2022, which of course, partly relates to supply chain issues that emerged during the pandemic. The Ukraine war has certainly had a significant impact on food supply chains. The upshot was we had food price increases that we hadn't seen since the early 1970s. So that's where we were this time last year in terms of the maximum benefit, even with those improvements back to not covering the vast majority of counties in terms of cost adequacy. That cost-of-living adjustment helps somewhat, but I think the lesson we should take from this is that we have an underlying adequacy problem with the Thrifty Food Plan. It's really a bare bones assumption set, and a lot of folks have advocated that we move away from that to something that's called the low-cost food plan. It's a little bit more generous. It's a sort of bare bones basic shopping, but the Thrifty Food Plan may just not be the right template anymore. And if we want to tackle the persistent issue of food insecurity in this country, we've got to deal with this underlying SNAP adequacy issue.   I think this is really an important issue. I want to push a little bit further on the Thrifty Food Plan itself in terms of what it means. Please correct me if I get it wrong. It's this idea of a least-cost diet that is nutritionally adequate. It's looking at the dietary guidelines to help provide constraints to make sure people are eating a nutritious meal and it's also based off a minimum cost expenditure for what that diet would look like. It's based off a family of two adults and two children, and it doesn't incorporate lots of different family structures. Is that a fair assessment? And are there then some concerns about what the Thrifty Food Plan is?   I think what you're suggesting is basically correct and one of the issues about the Thrifty Food Plan is that when it was first developed, it really wasn't envisioned as a sustainable diet. It was really more of an emergency sort of meal plan. Like you're very strapped for resources, you can provide minimal nutrition for your household. But this is not what we want for people on an ongoing basis. One of the problems about the assumptions in the Thrifty Food Plan has also been that when we think about a household of two adults and two children, well, children eat really differently depending on their age, right? A five-year old doesn't eat anything like a 15-year-old. There are a lot of issues around household composition, but also just what do we mean when we say we want nutrition security for people, right? We want people to be able to eat healthfully in a sustaining way and I really think our ongoing look at SNAP adequacy suggests we're not there. We're not leveraging the tools we need to tackle not only food insecurity, but the fact that we have an epidemic of chronic diet-sensitive disease in this country.   Thank you for that. You know, this raises important questions about policy frame and the policy space around food access and food security. The Farm Bill is usually the legislative vehicle for making major changes to SNAP. But this past spring, the debt ceiling debate negotiations resulted in adjustments in the SNAP work requirements for some groups and new exemptions for others. What changes were made? And more broadly, what does research tell us about the impact of work requirements and time limits?   It's been an interesting year, to say the least, for the progress of the Farm Bill. Just to remind everybody, the Farm Bill is that place that we normally make major changes and reauthorize significant federal nutrition programs like SNAP roughly every five years. This year, the debt ceiling negotiations sort of preempted a lot of the ongoing discussion in preparing for the Farm Bill, because it took up this issue of time limits specifically focused on benefits for what we call individuals who are able-bodied adults without dependents. Sometimes, you'll hear the term ABAWD. I prefer not to use it because people are not the policy, but it's really focused on single adults who don't have custodial children. The idea is that if you are not able to meet a minimum work requirement of 80 hours a month or equivalent activities, you are limited to three months of benefits in a 36-month period. So that's extremely draconian, especially when we think about what we all know about the instability of low-wage work, right? And in periods where we have widespread unemployment, like we did for a bit in the pandemic, we have the ability to waive those requirements for everyone but they are now coming back. In addition to them coming back, they are now being increased in terms of the number of people it will cover based on the debt ceiling deal. It used to be folks 18 to 49. It will phase in now for people up to age 55, which is also an interesting thing. Because as people age, they sometimes have less ability to be flexible in the workplace and to move into new positions. There's a whole another conversation we could have about that. I guess a bright side of the debt ceiling bill was that it also created some new exemptions for those requirements, and they were focused on very specific groups including veterans, people who are unhoused, and young adults moving out of foster care. So those are all groups that we know are particularly vulnerable when it comes to just monthly finances and their ability to engage in the workplace. And that's a good thing but it doesn't mean that there aren't lots of other folks out there who have other significant challenges that ought to be recognized. And because it's a very sort of discretionary kind of process, we don't even have confidence that everyone in those groups we just talked about would actually receive a waiver. So why does all this matter? It matters because there's quite a body of research now that suggests that these time limits and work requirements don't do what they set out to do, which is to meaningfully increase either work effort or household income. They don't really accomplish the stated goal. They also cost money because you have to administer them and have a lot more interaction with the clients. And not only then do they not achieve those work goals, but they actually push a lot of people off of SNAP and/or trim them through, as we call people who move in and out because of administrative problems. What we have is a group who already has higher than typical food insecurity rates. We're making it more difficult for them to engage in SNAP. And SNAP is our number one tool for reducing food insecurity from the federal program portfolio. On balance, I think a lot of folks in the food security space would argue that time limits should just go away, right? That's not where we should be putting our investment if we want people to have more self-sufficiency and if we want them to eat better.   I really do appreciate the way you are humanizing the experiences of individuals who may depend on SNAP, but as the new policies are being implemented, may age out in a strange way. This is really a useful way for us to understand the implications of when we make decisions or changes to policy, it can have really negative consequences and may not achieve the goals that are at least stated. This is an important part of this conversation. But we're looking at a federal shutdown and if an agreement isn't reached, we could see some serious implications for families. Some lawmakers are calling for across the board cuts of most discretionary spending programs as part of any agreement. Would those cuts affect federal nutrition programs?   Good question, so the short answer is it's just going to be generally disruptive across the board, but the type of program does matter. So SNAP is what we call an entitlement which means that anybody who is eligible for it will receive those benefits on an ongoing basis. But another very important program that many people are familiar with is called WIC and that is a program focused on prenatal care and postpartum care for moms and infants and children up to the age of five. WIC reaches millions of children across the country, and it is not an entitlement program, which means that it's subject to an annual budget. We already have a problem with the WIC budget this year because we've had bigger increases in enrollment than were expected. I think that speaks to this issue about the continuing pressure of food prices, the loss of other pandemic supports at a time when families are still struggling to navigate basic needs. We've had more pressure on the WIC program and there was already concern that there would not be sufficient funds, let alone going into a shutdown situation. The administration has estimated that there will be a significant impact on families who will not be able to receive WIC if the shutdown were to persist. And then the bigger issue is that the time that we invest, so to speak, in shutdowns is time we're not working on the Farm Bill and having a thorough reassessment of program needs. It's likely to delay the Farm Bill agreements as well. While shutdowns, you know, are obviously very much about politics for people who have to put food on the table every week, some of which are paid for by federal salaries, right? Then this is a very real economic shock and it's unfortunately an economic shock that we could avoid.   Yes, it is important to think about how we can avoid this and reframing this as an issue about politics. But at the end of the day, there are families who are dependent on these policies, and we just had a conversation with Travis Smith at the University of Georgia about what happens when kids roll off WIC and that sort of in-between time before they enter school and that had this negative effect on the nutritional quality that these children consumed. And you can imagine that if there are disruptions in WIC while it's a smaller program than SNAP, it has important implications for the wellbeing of the families that use it. This is an important time and I'm hopeful that we will move past this impasse. Discussions about how to strengthen healthy eating for the US population are ever present. And this is particularly true for those individuals who participate in the SNAP program. What proposals are being considered for SNAP and how could we see any of those in the Farm Bill?   This is a really important topic because we actually have an evidence-based strategy for increasing the ability to purchase healthier foods like fresh fruits and vegetables and that is what they call nutrition incentives. Some people will know it as Double Up Bucks, but basically, they're programs that allow people to receive additional money for SNAP if it's put towards those kinds of purchases. That's something that's been evaluated over the last several years and seems to do exactly what we want, which is to increase those purchases. Unfortunately, it's a grant program. It's not an integral part of SNAP. It very much depends on where you live and what year it is as to whether you can access that kind of program. We're underutilizing a tool that's already there and the Farm Bill does currently reauthorize that grant program. Some people will maybe know it as what's referred to as GA/SNAP grants. But we did an analysis and showed that while they do a good job of targeting GA/SNAP grants to areas of high food insecurity, there's still lots of high food insecurity areas that don't have one available, and they're always time limited to a few years. We're not using the knowledge that we've already gained to accomplish this goal again that we're beginning to talk about, which is to really focus on nutrition security and not just basic adequacy of diet. The other thing that people often raise is, well, perhaps we should restrict purchases of certain kinds of benefits. And I think, in general, we find that Americans don't respond well to those kinds of limitations. And a concern, I think, that the food security space has about restrictions is that it's potentially very stigmatizing just to low-income people who are using a benefit when the truth is that most of America doesn't eat as well as we need to and that's a larger structural conversation. The upshot is some people would advocate for restrictions on things like soda and candy, maybe other snacks. I think we could all understand why we wouldn't want to prioritize that, but the fact of the matter is that restrictions don't make the other things more affordable, and that is exactly what the nutrition incentives are intended to do.   Bio   Elaine Waxman is a senior fellow in the Income and Benefits Policy Center at the Urban Institute.  Her expertise includes food insecurity, food access, federal nutrition programs, social determinants of health and broader issues affecting families with low income. Waxman previously served as the Vice President of Research and Nutrition at Feeding America. She has co-authored numerous publications, including an article on SNAP benefit adequacy in the Agricultural and Resource Economics Review, which was named the journal's Best Paper in 2019. She received her MPP and PhD from the University of Chicago, where she is a lecturer at the Crown School of Social Work, Policy and Practice.  

Today we speak with an expert on sugar and things meant to replace it. The stakes are high. Very high. Sugar consumption in the population is astronomical and so is the use of sugar replacements. Knowing the impacts of both could help experts provide dietary guidance and help consumers make decisions. Dr. Robert Lustig is Professor Emeritus of Pediatrics in the Division of Endocrinology at the University of California, San Francisco. He specializes on the regulation of energy balance by the central nervous system; body weight regulation, appetite, metabolism, and is very well known for his work on sugar and their substitutes and on policies aimed at improving the diet of the population. A YouTube video on the effects of consuming sugar called “Sugar: The Bitter Truth,” has now been viewed 24 million times. Interview Summary   URL for “The Bitter Truth video (https://youtu.be/dBnniua6-oM)   Let's start out with this - so the big hope is that sugar replacements, artificial sweeteners, non-nutritive sweeteners, all known as different things, replace sugar and that people can enjoy sweet taste without the calories. But, of course, the picture is way more complicated. Being an endocrinologist, you are in a good position to explain what happens when the sweeteners enter the body. I'd like to get to that in just a moment, but let's lead off with another question. Why is it so important for people to consume less sugar?   First, let's talk about what sugar is. The food industry tells you that sugar is just empty calories. I wish that were true. If that were true, then you could basically spend your discretionary calories on sugar with no problem. But it's not true. There are two molecules in dietary sugar: the sucrose or the high fructose corn syrup or honey maple syrup agave. They are all basically the same. One molecule of something called glucose, one molecule of something called fructose. Glucose is the energy of life. Glucose is metabolizable by every cell on the planet. Glucose is so important that if you don't consume it, your body makes it. The liver will take fats and turn it into glucose. It will take amino acids and turn it into glucose process called gluconeogenesis. Glucose actually makes your cells work better. It makes your mitochondria function better, the mitochondria being the little energy burning factories inside each of your cells. Glucose, for lack of a better word, we can call good. Fructose, on the other hand, it is completely different, is metabolized completely differently inside the body and inside the liver. What fructose does is it inhibits mitochondrial function. It actually inhibits three separate enzymes necessary for mitochondria to do their job. So, fructose inhibits energy generation. Now, the food industry will tell you fructose is four calories per gram. Fructose is ready energy. That is why they put high fructose corn syrup in the sports drinks, for example. Well, turns out, that fructose may be ready energy for a bomb calorimeter, but it is not ready energy for your mitochondria. You don't burn in a bomb calorimeter (a laboratory instrument), you burn via your mitochondria. It turns out, mitochondria are actually poisoned by fructose. So in fact, fructose is a chronic, dose-dependent mitochondrial toxin and this is why we have to eat less of it. But the problem is the food industry keeps putting it in anyway despite the fact that it is killing us.   How much more of it are people consuming than what you might suggest?   The American Heart Association years ago came up with a upper limit per day of about 25 grams, which would be about six teaspoons per day. I was actually part of that group that came up with that and I stick to it because that's what the data show. We are currently consuming 94 grams. We are consuming almost quadruple the amount that is the upper limit. Now, the notion that something could have empty calories but still be bad for you is not a crazy one. We have two things in our diet that we know are calories but are clearly toxic to us. One is alcohol. Alcohol, seven calories per gram, but alcohol is a poison. And then also trans fats. Trans fats are nine calories per gram, but trans fats are a poison. So just because something has calories doesn't have anything to do with its metabolic impact.   Where are people getting all the sugar from? I'm assuming it's not from their sugar bowl.   Exactly. It is not the sugar they add. It is the sugar the food industry adds. Now, where is it? Well, the obvious source is soft drinks. That's number one by far and away. I mean soft drinks are basically, you know, the devil incarnate. Several municipalities have actually figured that out, and it's one of the reasons we have soda taxes because it's actually directed at the problem. A lot of it is in other things that we identify as sweet: candy, cakes, ice cream. A lot of it is in other things like breakfast, cereal, yogurt, even cured meats. It is in a whole host of other things. When you add it all up, 65% of the sugar you consume is in ultra-processed foods. It is not in regular food. It is not in sugar you added to your own food. It is in ultra-processed foods. An ultra-processed food is the vehicle by which the payload, that is that fructose, is doing its damage.   Thanks for that background. We're really here to talk about the artificial sweeteners but it is irresistible talking to you about sugar in general because you described the whole picture in such a compelling way. So thank you for that. So, onto the artificial sweeteners. What are the main ones in the food supply?   Well, there are a whole bunch. The most common ones that the food industry uses the most, obviously aspartame, which is Equal. And also sucralose, which is Splenda. But there are others now out on the market: Neotame, there's Acesulfame-K, there's monk fruit, there's Stevia, and all the Steviol glycoside derivatives. There's now Allulose, and there's Tagatose. There's a whole host of different sweeteners that are considered "non-nutritive” meaning they don't have calories.   These things show up in ways that people don't necessarily recognize. I mean Diet Coke, Diet Pepsi, those sort of things, it's obvious they're artificially sweetened. But these things are showing up in a lot of places, aren't they?   Indeed. The food industry now understands that sugar is a problem and people have been calling for less sugar but what they're not calling for is less sweet. And so the industry has a job. It has to deal with that dichotomy.   I know understanding their impacts is complicated by the fact that there are a lot of these things and they're all chemically different from one another. I'm imagining they have different metabolic effects. What happens when these things get into the body?   Right, and that is the issue. It has nothing to do with calories. People think calories are the issue. This has nothing to do with calories. That's one of the reasons, Kelly, that I'm committed to one concept: kill the calorie. Kill the calorie as a unit of measure. It was never appropriate. It was actually subterfuge, and it was actually promoted and promulgated by the food industry because if it is about calories, they can assuage their culpability for what they've done to our food supply. This has nothing to do with calories. This has to do with metabolic health.   Now, the World Economic Forum just published a white paper called the, "True Purpose of Nutrition," and it comes down to two words: metabolic health. That is what is going on inside the cell and that's where the artificial sweeteners do their damage, inside the cell. That's what we have to talk about. There are several places in the body where artificial sweeteners can do damage that have absolutely nothing to do with calories. The first, you put something sweet on your tongue. Message goes tongue to brain, "Sugar's coming." Brain sends a message to the pancreas, "Sugar's coming, release the insulin." Then the sugar never comes because it was a diet sweetener. What does the pancreas do? It turns out it releases the insulin anyway even though it had no calories, even though it wasn't sugar, just because of the sweet taste. So this is known as the cephalic phase of insulin secretion. That insulin is driving energy storage into fat, number one, and it's also driving cell proliferation in your coronary arteries, cell proliferation in your breast tissue, in other words, cardiovascular disease and cancer and ultimately leading to burnout of your pancreas, and now you've got diabetes too. Even though these artificial sweeteners have no calories, they still generate an insulin response, which is still problematic from a metabolic standpoint.   So because of the sweet taste and the body's response to that, I'm assuming what you're saying would be true to all of sweeteners?   Exactly. All of them do that. The next step is the artificial sweetener goes down your gullet, goes into your intestine, and the intestine has these bacteria in it called the microbiome. Most people have now heard of that. Different bacteria lead to different effects in the intestine. But think of your intestine - I mean it's a sewer. It has a whole lot of S-H-you-know-what in there. The goal of the intestine is to keep the S-H-you-know-what IN the lumen of the intestine and not allow it into the bloodstream. It uses three barriers. It has a physical barrier called the mucin layer. It has a biochemical barrier known as tight junctions or zonulins. It also has an immunological barrier called Th17 cells. Those three barriers have to work right to keep the junk out of your bloodstream because if the junk gets into your bloodstream, you now have systemic inflammation, which drives insulin resistance and drives chronic metabolic disease as well. So keeping your intestine in tiptop shape is really important. Well, it turns out those diet sweeteners alter the microbiome. Some of those bacteria like those sweeteners and utilize them to make toxic byproducts, which damage the mucin layer, damage that biochemical tight junction barrier and allow for things to seep through. This is a process called leaky gut. For reasons that are still unclear, sugar tends to deplete those Th17 cells, rendering the immunologic barrier devoid of function. The sum total of which means all the you-know-what in your intestine ends up in your bloodstream, goes to your liver, generates insulin resistance, and you are off to the chronic metabolic disease races as well, from diet sweeteners having nothing to do with calories.   What an amazing picture your painting of these things.   We've got one more mechanism. At the fat cell, now this I really don't understand and it's early data but seems to be consistent. Turns out adipocytes, fat cells, have receptors for diet sweeteners. Don't ask me why. I don't know why. But it turns out, diet sweeteners can act like insulin right at the fat cell to increase energy deposition into the fat cell. Growing those fat cells all by themselves, due to the diet sweetener rather than due to insulin. Now how dumb is that? As a result, there are a lot of different ways diet sweeteners might end up causing problems as well, having nothing to do with calories, having nothing to do with fructose. There was a paper that came out in the European Journal of Clinical Nutrition. It was a meta-analysis of sugar and also of diet sweeteners in terms of diabetes and heart disease. What I can say in one sentence to sum up what this paper showed is that the toxicity of one Coca-Cola equals the toxicity of two diet Coca-Colas. Half as bad. That doesn't mean good. It means half as bad.   Boy, I mean, any one of the three major pathways to harm would be of concern. If you add them all together, it is a pretty striking picture, isn't it? I imagine, even if somebody knew about this, they might say, well, you know, I'm willing to accept those risks. I mean, even though you are making them sound substantial, but I'm willing to accept those risks if these products help me control my weight. Do they?   Well, they don't. That's part of the problem. There is not one study, not one study in the entire world's literature, that shows that switching from sugared beverages to diet beverages actually controls weight. The reason is because even though the diet sweeteners don't release as much insulin now, when you drink the diet sweetener, the pancreas releases it later. That's actually been shown in several studies now. You get a delayed insulin response, so that the 24-hour insulin burden is the same whether you consume the sugar or the diet sweetener.   Let's talk about safety for a minute. What about sort of the typical toxicology concerns that people have had for years about these substances, irrespective of what they're doing to the pancreas and to the other, the microbiome, et cetera? What about the just kind of pure safety of them?   Right, so the one that has generated the most heat, not too much light, unfortunately, is aspartame, NutraSweet. It turns out that aspartame has a very long and checkered history. Did you know that aspartame was made by Searle, G.D. Searle? And, do you know who the CEO of G.D. Searle was at the time that aspartame was approved by the FDA?   I do not.   His name was Donald Rumsfeld.   An interesting character in history.   Indeed, wouldn't you think? It turns out that G.D. Searle actually buried most of the toxicology of aspartame in order to get it approved. It is a long complicated and involved story, which we don't have time for. I'm not even privy to most of the details on that. The bottom line was it ultimately did get approved despite the fact that there was a significant amount of concern about toxicology of this compound. Those questions still remain today. That is one. Another one that is a big issue is sucralose. Sucralose is also called Splenda. Sucralose is a chlorinated poly-fructose and it's extremely sweet, no question about that. It seems to have some GI side effects that a lot of people don't like. It also has now been associated with cancer. And most recently, the one that's gotten the most attention and almost assuredly, Kelly, the reason you called me is the paper that came out about three weeks ago in science about erythritol. So erythritol is a sugar alcohol, and now the meta-analysis of erythritol consumption suggests that it may in fact contribute to heart disease. Now, is that true? Meta-analysis are complicated. People think meta-analysis are the piece de resistance, the highest bar of medical information and analysis. I have four words for meta-analysis: garbage in, garbage out. Meta-analyses are only as good as the studies that they base the data on. If those studies were done by the food industry, which almost all of these are, because that's who stands to benefit from them. These are almost never NIH studies. These are almost always food industry studies, as you know, the odds are 7.61 times more likely to find in favor of the compound of interest. So all of these are, shall we say, biased. All of these are tainted, and meta-analyses are basically a conglomeration of tainted studies. So what do you expect the result to be?   Thanks for that background. I'm imagining also regarding toxicology and safety, that some of the newer sweeteners like Splenda for example, sucralose, there hasn't been enough years of use to pick up long-term chronic effects.   Well certainly, if you're using cardiovascular or cancer events, you're absolutely right. A lot of these events, you know, take a long time to manifest themselves. Sometimes, a generation or even two generations for that matter, especially for heart disease and cancer. The 15-year-old is drinking 10 diet sodas. When do you expect the heart attack to show up? You know, it's complicated.   So we use biomarkers to try to answer these questions, but then the biomarker has to actually be a good proxy for those events and often they're not. Let me give you an example, LDL. Everybody thought LDL was the bad guy. Turns out triglycerides are the way worse guy. LDL has a hazard risk ratio for heart disease of 1.3. Triglycerides have a hazard risk ratio of 1.8. Triglycerides are 50% more important in determining heart disease than LDL is, but we use LDL as the biomarker because it's more stable. So you have to use the right biomarker and you have to interpret it properly and it actually has to mean something and it has to change relatively acutely. All of which are problematic for all of these biomarkers. It's hard. It's hard to do these kinds of analyses. Having said that, my group, a scientific advisory team that I convened to help an offshore ultra-processed food company improve the health of their products. We've published this just last month in Frontiers in Nutrition. The company is called Kuwaiti Danish Dairy Company, or KDD. The title of the paper is, "The Metabolic Matrix: Re-Engineering Ultra-processed Foods to Protect the Liver, Feed the Gut, and Support the Brain." We did a deep dive on diet sweeteners. We looked at all of these diet sweeteners and their proxies, all the biomarkers. The one that actually popped out that looked to be the most beneficial, at least acutely, is a new one that we're actually kind of interested in and is picking up speed and it's called allulose. Allulose currently is 12 times the cost of sugar, but that's coming down. It turns out allulose lowers LDL and raises HDL. So it may have a better cardiovascular profile, but again, all the caveats that we mentioned before.   That's very interesting. So given your interest in pediatrics, what about children using these sweeteners?   I am totally against children using sugar because they get fatty liver disease and Type 2 diabetes, and I am totally against them using diet sweeteners because, number one, we don't know what they're going to do. Number two, they don't actually lead to weight loss. That data we do have. So as far as I'm concerned, we really only have one option and that is de-sweeten our lives. We have to de-sweeten the food.   Perfect lead in to the next question I was going to ask. So do you think it is possible for people to become accustomed to less sweetness? I mean, let's say the food industry is required to gradually reduce sugar and sweetness from the sweeteners. What do you think would happen?   Absolutely. It is not only possible, it is eminently doable. And I know why and we have the data for why that is. So there is a very smart lady, neuroscientist at the University of Michigan by the name of Monica Dus, who has done all this work in fruit flies of all places. She has shown the desensitization of the tongue to sugar has to do with changes in receptors and changes in specific substrates in the taste buds of the tongue. When you stop the sugar availability, it takes three weeks for those receptors to increase and repopulate, and for those problematic substrates to go away. You can actually retrain your tongue in three weeks to be much more sensitive to the sugar that is in the food naturally. After a three-week abstinence period or a reduction or a weaning period, a blueberry will taste like a sugar bomb in your mouth. So we know this can happen and we actually have proven this for salt previously. The UK, as you know Kelly, back in 2003, the Blair government convened all the food industry concerns in Great Britain. So Marks & Spencer, and Weight Rose, and Tesco, et cetera, all around the big table, didn't let media in, and basically said to every single food industry concerned in Great Britain, "Look, we have a hypertension and stroke problem and it's because of the salt content of the food and we are going to play referee here in the government. And each of you is going to reduce the salt content of your food by 10% per year over a three-year period so that you'll reduce your salt by 30% at the end of this and everyone's going to play together, so that there's no competitive disadvantage and most importantly, we're not going to tell anybody." That's what they did. Sure enough, in 2011, a paper appeared in Burge Medical Journal, demonstrating a 40% reduction in hypertension and stroke because of the public health effort that the Blair government made in terms of reducing the amount of salt in processed food. We can do the same with sugar today.   The salt example is a good one because I think many people have sort of experienced this in their day-to-day lives, even in the United States, where industry hasn't done exactly what's happening in Britain. People have tried to reduce salt in their diet, add less salt, and buy products with less salt. And then sometimes they'll go back and consume something that they had before and find it extremely salty, even unpleasantly salty. It's interesting to hear on the sugar front that that same experience might be possible and that there's a biological reason for it. It is not just that you psychologically get accustomed to different levels of sugar, in this case, but there's a biological change occurring that might help keep that going.   Absolutely. You can change people's behavior by changing their biochemistry. This is how I got into this field by using a drug that suppressed insulin and getting kids who were 400 pounds due to their brain tumor to actually lose weight and start exercising because we got their insulin down. You can fix the biochemistry and the behavior will follow suit. The food industry could do that and we wouldn't even notice.   So I'm guessing I know the answer to this question before I even ask it, but let's go ahead. Would you suggest the food industry be mandated to make gradual reductions in sugar, just like you mentioned with salt in the UK?   Absolutely, I'm working toward that. The only thing that I say is we should not tell anybody.   So it would be sort of a stealth move then. You would not necessarily have to make a big deal of it to the public, because they might assume there's going to be a change in the desirability and the pleasure of the products when that's not necessarily the case.   As soon as you do something to their food, someone's going to scream, "Nanny state!" This is not nanny state. Ultimately, this is a public health problem. We have to deal with it with a public health solution. You know, that means changing things. If the amount of sugar in our food supply went down, say by 3% every six months down, so that we were able to cut our sugar consumption by 25%, which would be the same basically as what a tax would do. We would save so many billions of dollars in healthcare costs, and we would increase productivity so much. We actually published a paper, a microsimulation analysis in BMJ years ago where we quantified the savings to government, to insurers, to the public. If we actually got sugar down and, you know, actually listened to what the USDA told us, it would be amazing. There is data, there's a pathway forward, there's precedent for doing it. I absolutely think that is where we need to go.   Rob, you're making me feel very smart at the moment, because I figured this was going to be a podcast filled with information and helpful bits of knowledge and it sure was. I'm really grateful that you were able to join us and the topic couldn't be more important. Thank you again for being with us.     Bio   Robert H. Lustig, M.D., M.S.L. is Emeritus Professor of Pediatrics in the Division of Endocrinology, and Member of the Institute for Health Policy Studies at UCSF. Dr. Lustig is a neuroendocrinologist, with expertise in metabolism, obesity, and nutrition. He is one of the leaders of the current “anti-sugar” movement that is changing the food industry. He has dedicated his retirement from clinical medicine to help to fix the food supply any way he can, to reduce human suffering and to salvage the environment. Dr. Lustig graduated from MIT in 1976, and received his M.D. from Cornell University Medical College in 1980. He also received his Masters of Studies in Law (MSL) degree at University of California, Hastings College of the Law in 2013. He is the author of the popular books Fat Chance (2012), The Hacking of the American Mind (2017), and Metabolical: The Lure and the Lies of Processed Food, Nutrition, and Modern Medicine (2021). He is the Chief Science Officer of the non-profit Eat REAL, he is on the Advisory Boards of the UC Davis Innovation Institute for Food and Health, the Center for Humane Technology, Simplex Health, Levels Health, and ReadOut Health, and he is the Chief Medical Officer of BioLumen Technologies, Foogal, Perfact, and Kalin Health.  

As a society, we are eating and drinking low-calorie sweeteners more and more. Researchers are working to understand the long-term impact of such sweeteners for adults and, of course, for children. This interview is part of a series on the impact of sweeteners. Our guest today is Dr. Allison Sylvetsky, Associate Professor in the Department of Exercise and Nutrition Sciences at the George Washington University - Milken Institute School of Public Health. Interview Summary   Boy, these sweeteners are in the news all the time, and that's been the case for many years. And people are really interested in whether they're safe, whether they help people control their weight and the like. You have a vast knowledge on this, and I'd like to begin with kind of a fundamental question. So, how has the consumption of these sweeteners changed over time? How much are they being used and who is using them?   What's really interesting is that these sweeteners have been around, at least some of them, for quite a while. But what we've seen is that as there's been more and more emphasis on reducing the consumption of added sugars and sugar sweetened beverages, there's been a widespread increase in the use of various low-calorie sweeteners in the food supply, which of course has been followed by increases of consumption. So, across all different population subgroups, we're seeing increases in the intake of low-calorie artificial sweeteners.   So, how much are they used and who are the people who are using them the most?   So, in terms of how much they're used, that depends to some extent on how we look at this, because it's very hard to actually quantify the intake given that manufacturers are not required to disclose the amount of different artificial or low-calorie sweeteners in food and beverage products. So, most of the data that we have to rely on either comes from household purchasing data or comes from self-reported dietary intake data from large surveys, for example, the National Health and Nutrition Examination Survey. But, what we've seen in these data are that low-calorie sweeteners are being used across the population, though the highest consumption or highest prevalence of consumption is seen in females, in individuals with diabetes and obesity, individuals from higher-income households, and also older adults and older individuals. However, more and more, we are also seeing consumption of low-calorie sweeteners among children, and consumption in products that people wouldn't necessarily expect would contain these artificial or low-calorie sweeteners.   Let's talk about that. So, where do the low-calorie sweeteners show up in the food supply? Has this changed over time?   This has definitely changed over time. Several decades ago, you would think of low-calorie sweeteners as being in diet beverages, which of course they still are. Or in sweetener packets that you find on the tabletop. For example, Sweet'n Low that contains saccharin or Equal that contains aspartame. But now we're seeing these sweeteners showing up across product categories. So, in products including light yogurts, artificially sweetened yogurts, dairy desserts such as ice cream, snack foods such as microwave popcorn, cereals, ready-to-heat oatmeals, all sorts of different products, protein bars, protein shakes, really, you name it. I've actually even seen low-calorie sweeteners show up in pickled ginger that usually is used along with sushi. So, again, places where people just wouldn't expect to find them. We see these sweeteners popping up, and this is more and more the case as there's been more and more emphasis on reducing the intake of added sugars.   Low-calorie sweeteners in microwave popcorn, who would've thought? I mean, that's just one example and you gave other ones about where these things are showing up. So, big time exposure to these, isn't there?   Exactly. Also, something like microwave popcorn typically wouldn't be thought of as a diet food, and that's part of what is very confusing to consumers. It's one thing if the product is labeled as "diet" or "no sugar added" even. Not that everybody would recognize that as perhaps being suggestive of having a low-calorie sweetener, but in products like microwave popcorn or certain English muffins, for example, people typically aren't using these products as a way to manage their weight or as some sort of a diet or reduced calorie food, because they're not diet or low-calorie foods.   Let's get right to one of the most fundamental questions of all. What are your thoughts on how these low-calorie sweeteners affect health?   So, that is the big question, and there's a lot of uncertainty and there's been more and more research on the topic, which has been exciting and informative. But there still are a lot of questions with regard to how these sweeteners affect health. One thing that is important to clarify right from the start is that, at least the work that I do and the work that a lot of people are focused on to understand their health effects, is different from more of a traditional toxicological safety assessment. So, when I'm talking about their effects on health, I'm really referring to their metabolic and health effects, their role in weight management and chronic disease prevention as opposed to more traditional safety outcomes. Because of course, these low-calorie sweeteners have been reviewed and approved for use in food by the Food and Drug Administration and other regulatory agencies worldwide. But, in terms of weight management and chronic disease prevention, what's really interesting is, it depends on the type of evidence that you look at. There have been quite a number of randomized control trials primarily in adults that have shown that when added sugars or sugar-sweetened beverages are replaced with low-calorie sweeteners on a one-to-one basis, there typically is either a neutral effect or a modest benefit. Where we do see some modest reductions in energy intake as well as a modest reduction in body weight. But that doesn't necessarily tell the whole story because that doesn't necessarily reflect how they're used, especially given what we've just discussed about the use of low-calorie sweeteners in the food supply. What's interesting is when we look at observational evidence from large perspective cohort studies, typically the vast majority of these studies show positive associations between consumption of diet beverages and low-calorie sweeteners with a variety of adverse health outcomes. This includes higher risk of obesity, higher risk of diabetes, heart disease, and some recent studies also showing an increased risk of certain types of cancer.   So that then leads to the question of: well, what explains this discrepancy? There are several explanations. One is that there are flaws to any type of study, including that a lot of these studies that look at associations may be subject to reverse causality or sort of a chicken and egg situation - which is what's happening first. But they're also very plausible biological and behavioral mechanisms that have been put forth to explain how low-calorie sweetener intake may be causally related to some of these outcomes. And that's really where a lot of the research is focused right now, is trying to understand, what do these low calorie sweeteners actually do metabolically in the body and how does that impact health?   That whole range of metabolic consequences is a very interesting one. You led off this discussion by mentioning toxicology, and I realize that you're not a toxicologist, nor am I, but I do have a question in that arena. Whatever standards of the FDA uses to assess safety for these things, I'm assuming it's a range of standard toxicological tests, do you think there's still a chance that these things, even though they're considered safe, will have long-term consequences that people don't know about yet? Just because some of the newer ones, for example, haven't been on the market long enough for people to have 20 or 30 years of exposure? Is there a reason to be concerned on that front, do you think?   I would say there's a reason to be concerned in terms of while the levels that they're consumed are believed to be safe in terms of, as you said, these thresholds that are set forth based on toxicological data - we don't know what the threshold of exposure is that would be required to have these metabolic effects. When we're talking about metabolic and health effects, as you've alluded to, these are long-term processes, right? We don't develop diabetes or cancer overnight, but it takes months, years, decades of exposure to see some of these outcomes. So, it is very possible that even though these are safe from a toxicological standpoint, the repeated exposure in the ways that we consume them, in addition to the fact that we don't consume these in isolation, we consume low-calorie sweeteners in combination with each other, other low-calorie sweeteners, as well as other food additives, other ingredients in various forms. So we don't fully understand yet what that means for long-term human health.   Thank you for that explanation. Thus far, we've been talking about these low-calorie sweeteners as a group, but of course there are different compounds that have different biological effects. What do you think about the different effects of the different versions of low-calorie sweeteners?   That's become an extremely important question, especially because over time there's been changes in not just the use of low-calorie sweeteners as a group, but in certain low-calorie sweeteners. As you mentioned, these sweeteners are different compounds. Of course, they're grouped together because they contain characteristics, such as low-calories that have high potency sweetness and are palatable replacements for added sugars in food. But they are of course, different compounds. And therefore, while they may have some overlapping effects due to their sweetness, they also may have different effects due to their specific chemistry and their way that they are absorbed, metabolized, processed in the body. That's something that we're really, as a field, just beginning to understand. In a lot of the research to date, low-calorie sweeteners have been referred to as a group. And that's in part because, especially in observational studies, it's very difficult to tease out which ones are being consumed. And that's in part due to limitations of dietary assessment approaches, and in part due to constantly changing formulations of these products by food and beverage manufacturers.   So, it's difficult in a lot of the existing research to actually tease apart what specific low-calorie sweeteners we're talking about. That said, there is more and more of an emphasis on trying to understand these as individual compounds and then hopefully be able to make more tailored and nuanced dietary recommendations for or against their consumption. There's been some recent studies looking at, for example, comparing different low-calorie sweeteners on outcomes such as body weight over 12 weeks. What that study showed (that was a study out of Purdue University), is that while saccharin consumption actually led to weight gain that was similar to real sugar, sucralose consumption in this particular study led to reductions in body weight. So, while this is just one example, clearly it's possible and likely that these sweeteners may actually have some different effects, which really reiterates the need to look at them separately and compare their effects on different outcomes.   It's interesting that you mentioned the research at Purdue, and I'd like to remind our listeners that we reported a podcast with Dr. Richard Mattes, who's a professor at Purdue, who's done a good bit of work on this topic. So, let's turn our attention to children. And I know many parents are very concerned about consumption of these products by their children. So, is their worry warranted? What do you think about use of these things in children?   Yes, I would say their worry is warranted. That said, it's also not conclusive that these are harmful, but at the same time, it's not conclusive that these are actually beneficial for their intended benefits of helping to reduce sugar intake and help with weight management. Really when it comes to kids, it's a question of how you look at the data, because what is obvious is that there is a lack of data in kids. In some cases, kids could be thought of as small adults. But kids also are very different than just being small adults, not just because they're smaller, but because they're developing. And we know that early life exposure makes the difference in terms of future dietary patterns. Given that there are many questions about the metabolic and health effects of low-calorie sweeteners in adults that have yet to be answered, to start in a widespread manner, providing these to children is concerning until we have a better handle on how these actually work in the body. As mentioned, there is very limited evidence in children, but at the same time, we've seen an explosion of low-calorie sweeteners in products, including products that are directly marketed to children. For example, fruit drinks that have often added sugar in addition to low-calorie sweeteners such as sucralose and acesulfame potassium. We've done some work talking to parents as have others, and trying to understand, "Well, what do parents think about this?" And most parents will tell us that they do not want to provide these to their children. Meanwhile, other research has shown that parents cannot identify or recognize products that contain them. What's happening is that given a lot of different factors, but particularly the fact that more and more of these sweeteners are showing up in children's products, children are being exposed to low-calorie sweeteners from a very young age. And it's unclear what that means for their health. There is reason to be concerned, both based on data in adults as well as some of the more mechanistic evidence that's come out recently related to how these sweeteners may adversely impact glucose homeostasis or insulin resistance, or alter the composition of the gut microbiome. There are a lot of questions when it comes to this topic in general, but particularly for children, it would seem that we may want to take a more cautious approach before widely incorporating these into products that are going to be consumed by youth.   What are some of the key questions that people in this field are addressing now?   So, some of the key questions, and there are many of them, but one is really just to understand the mechanisms through which these sweeteners work, both as a group and individually. That will provide really much needed insight to explain these epidemiologic findings and also to understand some of the discrepancies between the randomized control trial literature and the observational data. That's one big area of focus. Another is to understand early life exposure. Both exposure among children as well as intergenerational exposure. What happens when a pregnant mother or breastfeeding mother consumes these every day or multiple times a day? We know that they are transferred to the baby. In the case of breastfeeding, for example, we've done some work in that area. What we don't know is what that actually means for the child in terms of their taste preferences, their appetite, their weight trajectory, and their future health. Understanding that early life exposure and intergenerational transmission, as well as focusing on cardiometabolic outcomes beyond body weight. So, we know that when these are used in a certain way, very judiciously, these may... Low-calorie sweeteners, and I'm generalizing the term here, but may be useful for helping with weight management. But we need to study these in a way that better reflects how they're actually consumed in real life. And then also, as we've already discussed, really start to understand the effects of these different compounds as individual sweeteners in addition to as a group of compounds that have some similar sensory property, that being that they're sweet. I think those are some of the main areas in addition to continuing to translate some of the more mechanistic work that's been done in rodent models into the context of human consumption.   The whole idea behind these artificial sweeteners in the first place is that people enjoy sweet taste in things. And so, why not go ahead and provide that? And it better to have it in some form that's not creating the same health problems that sugar has. But what about just changing that assumption and saying that people should get accustomed to less sweetness in things overall, which would then lower intake of both artificial sweeteners and sugar. And I'm wondering if you think that might be possible? Let's just say that the food industry agreed to or was required to reduce the sweetness in its food by 5% each year for the next 15 years or whatever it would be, so that people wouldn't notice it from year to year, but generally you would get accustomed to lower levels of sweetness in things. Do you think that would be possible for people to become accustomed to?   I would think it would be possible, certainly that we know that repeated exposure to different levels of sweetness will affect sweetness preference and dietary choices. What you're describing is very similar to what's been done with sodium in terms of gradual voluntary reduction of sodium. And I am aware, and as I'm sure you are, of efforts through, for example, the National Salt and Sugar Reduction Initiative (NSSRI), to do exactly that, which is to set targets for lowering the sugar content and therefore lowering the sweetness, assuming that there's not replacement with low-calorie sweeteners of different products across different product categories. I think there is a lot of promise in that concept, but I do think we would need to obviously see how that actually affects various outcomes before knowing whether it was effective or not. But I think that concept of it's not just sugar, but also we need to think about the sweetness and how that pertains to other dietary choices and longer term dietary patterns, is really important.   Bio Dr. Allison Sylvetsky is an Associate Professor in the Department of Exercise and Nutrition Sciences and is Director of the Bachelor of Science in Nutrition program at the George Washington University Milken Institute School of Public Health. Dr. Sylvetsky joined the GW faculty in 2014, prior to which, she was a post-doctoral fellow in the Diabetes, Endocrinology, and Obesity Branch of NIDDK in the Intramural Research Program of the National Institutes of Health (NIH). She received a doctorate in Nutrition and Health Science from Emory University. Dr. Sylvetsky's research focuses broadly on obesity and diabetes in youth. Her primary research interests are in studying the consumption and health effects of sugar-sweetened beverages and low-calorie (artificial) sweeteners, with a key focus on their consumption during childhood.  

In 2016, the Chilean government implemented a comprehensive set of obesity prevention policies aimed at improving the food environment for children. Results from a multi-year study of that regulation, published in the International Journal of Behavioral Nutrition and Physical Activity, can now tell us if Chilean children are better off as a result of the policy. Guests on this podcast include: Dr. Gabriela "Gabi" Fretes. She is an Associate Research Fellow at the International Food Policy Research Institute. Dr. Camila Corvalan is the Director of the Center for Research in Food Environments and the Prevention of Chronic Diseases Associated with Nutrition at the University of Chile. And, Dr. Sean Cash is an economist, Associate Professor of Agriculture, Food, and the Environment, and the Bergstrom Foundation Professor in Global Nutrition at Tufts University. Interview Summary   Sean, let's set the stage for this conversation. When crafting food policy, what should policymakers consider with respect to children and adolescents, both as current and future consumers in the food system?   I would argue that children and adolescents should be a priority, if not the priority in how we consider dietary policy for a few reasons. In the United States and elsewhere, we often argue quite heatedly about the proper role of government, with the arguments for health-promoting policies seemingly running into conflict with concerns about paternalistic interventions and restrictions on personal choice. These are important and perhaps unavoidable discussions to have. But when it comes to kids, we've already long had standards for school meals, what packaged snacks can be sold in schools, etc. We don't treat children as legally independent in other ways. So while there's still a lot of room for disagreement, it may be less daunting to actually keep child nutrition in the forefront when we consider how food policies around diet need to evolve. Perhaps more importantly, I would note that food marketers have long seen children as an important three-in-one market. One, kids have influence over food choices within their households. Think of a kid shopping with a parent in a supermarket and pointing at things she'd like mom or dad to buy. We sometimes call this pester power. Two, kids have their own spending money, and much of what they choose to spend it on is food. Often the types of energy-dense, nutrition-poor snack foods that are exactly the foods subject to labeling under the Chilean law we're talking about today. And three, kids grow up to be adult consumers, and their preferences and knowledge are heavily influenced by the things to which they're exposed in childhood. For the same reasons that food marketers are interested in children, policymakers should be. Kids have influence in in their households now. They're buying food on their own now. What they do now will influence their future behaviors and future health.   Thank you, Sean. I have got to say, I went grocery shopping with my child yesterday and I appreciate your thoughts on how we should think about what policymakers should engage, not just in the U.S. but anywhere when we are thinking about helping kids make good choices that will have long-term implications. Thank you for that. I want to turn our attention to the research paper that we're discussing now, titled, "Changes in Children's and Adolescent's Dietary Intake "After the Implementation of Chile's Law "of Food Labeling, Advertising, and Sales in Schools." So, Gabi, my question to you is this. One of the key components of the Chilean law was regulating food offerings in schools. Can you explain the focus of that policy and how it is intended to work?   Yes. Before we speak about schools, we should speak about Chile's law in general. Chile's law of food labeling and advertising includes three main components. The first one being mandatory front-of-package warning labels on packaged foods and beverages. The second being restrictions on all forms of food marketing directed to children younger than 14 years. The third one is school regulations at the preschool, elementary, and high school levels. Briefly, food manufacturers must place front-of-pack warning labels on packaged foods and beverages that are high in added total sugars, saturated fats, sodium, and energy. This law was implemented in stages starting in June, 2016. The law mandates that food and beverages with at least one front-of-pack warning label cannot be sold, promoted, or marketed inside schools. That includes school kiosks, cafeterias, and events that happen inside schools. Additionally, food and beverages with front-of-pack warning labels cannot be offered as part of the school meals program or as free samples or gifts. Chile's set of regulations is unique because it includes a package of interventions covering several aspects of the school food environments, such as the availability of foods for sale inside schools, school meal program standards, and restrictions on food marketing directed to children.   Wow, Gabi, this is a very comprehensive law. So what did the team hope to test in the longitudinal study? Could you explain the main findings?   Yes. So with this study, our team aimed to assess if children and adolescents' intake of total sugars, saturated fats, and sodium consumed at school changed after the initial implementation of the regulation. The team was also interested in exploring how children navigated different food environments. We also evaluated changes in intake at home and different settings from home and school. So, what did we find? Intake of most nutrients of concern, those nutrients under the scope of Chile's law, including total sugars, saturated fats, and sodium significantly declined at school both for kids and adolescents. At home, we also found significant declines in kids' total sugar intake, but no changes for adolescents. What makes this more interesting even is that we found evidence of partial compensatory behavior at restaurants, corner stores, street food, among others. Which means that kids and adolescents were consuming less healthy foods outside their school and home.   Thank you, Gabi. I want to now turn to Camila. I'm really curious about this compensatory behavior. The study found this evidence of students compensating somewhat for the healthy foods at school by eating more sugars, saturated fats, and sodium at other locations outside of school. Why do you think this happened?   Norbert, I believe this is a very interesting finding, and there are probably three main reasons why we observed this result in the study. First of all, we know that children, as they age, start to consume much more food from places outside of home. This is something that has been shown previously. We know that when kids start to age, they start to get more sugar, more saturated fat, more energy from restaurants and fast food outlets. This is something that we would expect in a longitudinal study such as the one that we conducted. Secondly, the Chilean law did not include regulation around the schools - so in the neighborhoods that surround the school. This was originally part of the regulation. But, during the discussion and designing, we had to drop this component of the regulation. Basically what we approved is that there were restrictions in the schools, but outside there was no restriction in terms of marketing or the offer of unhealthy foods to children. Finally, it's likely that the regulation influenced some kids in a positive way. They really changed their behavior. But it's also possible that other kids did not really change their behavior. Once they had the opportunity of going outside of the school, they just kept buying unhealthy foods with high content of sugar, saturated fat, and sodium.   Thank you so much for that. It does reflect the complexity of the decision patterns that children have in terms of how they eat. I think this is true for all of us. If we are trying to improve in one area, there may be some changes in other areas. But I want to pick up on something you said about why you believe the result occurred the way it did. It had to do with dialogue that went on in Chile about the law. So, I want to ask now, how can we best center the needs and voices of communities in the development of similar regulations? It sounds like some of this happened in Chile. Could you share your thoughts about this?   Yes. So, during the process of developing the regulation in Chile, the Ministry of Health held some participatory discussion throughout the country with families, parents, school teachers, and different stakeholders to actually get their ideas and also assess their concerns about the different components of the regulation. We do believe it's very important to include the community's views when we define this kind of policies or programs because what we actually want to modify is people's behaviors. We really want to understand what is the best way of actually achieving that transformation. We really need to get their view for doing that. In Chile, we did not have a very strong civil society organization that could coordinate these views, and that is why the Ministry of Health had to actively engage the community through participatory dialogues that actually delay a little bit the implementation of the law. But, we believe that certainly strengthened their application.   It's really interesting to hear about this deliberative process and to see what ultimately came out of that. I want to turn my attention back to Gabi. In the big picture of policymaking, what can we actually learn from Chile's experience with the food labeling law?   Thank you, Norbert, and I think that we can learn a lot. But, I will highlight three things that we learned from this study. First, I want to say that Chile was the first country in the world that implemented front-of-pack warning labels on packaged foods and beverages high in sugar, sodium, saturated fats, and calories. So, the first thing that I want to highlight is that what's unique about Chile is that it wasn't only a labeling regulation but a comprehensive set of actions that included restrictions on marketing as well as school regulations. Food environments as a whole should be conducive to healthier and sustainable diets, and therefore isolated actions would be limited in scope. However, we need to acknowledge that the policy process in Chile was not without complications because there was significant pushback from the food and beverage industry. This is something that countries in the process of designing or implementing similar regulations should expect to happen. They should be prepared to respond with arguments based on evidence. The second highlight is that our results showed that the set of policy interventions may be promising to improve kids and adolescents' diets at school, but that actions in out-of-school settings should be strengthened to improve overall diets. So for example, I will cite some actions that could complement these regulations, such as the introduction of junk food taxes, the reinforcement of nutrition education in schools and the community, particularly relevant now as we move into the post-COVID-19 era, social marketing campaigns, actions in other settings such as menu labeling in restaurants, improving the availability and acceptability of healthier foods by street vendors, among other actions. And lastly, the third point that I want to highlight is that moving forward, countries should consider equity aspects to overcome structural barriers that limit people's ability to choose healthier foods and combine mutually-reinforcing strategies to stimulate a holistic food systems response where everyone has access to and can afford healthier foods.   Thank you for those comments, and I really do appreciate this idea of even though this was a comprehensive law, that there are some other spaces that the law could touch on or think about because of the results that we saw with this compensatory behavior. Thank you for sharing that. Sean, my last question is for you. I'm wondering if you could share your thoughts on whether Chile might serve as an example to inform the current front-of-package label discussions we're having right now in United States.   Oh, absolutely. Chilean law has already served as a model for consideration in many other countries in the region and around the globe, including in our top food trading partner, Mexico, which enacted a Chilean-style labeling law in 2020. Several multilateral health organizations have also expressed support for the Chilean approach to be used elsewhere. And it's hard to argue against the logic of policymakers in the United States paying close attention to what works well and what doesn't work in other countries in considering any policies around dietary guidance that we choose to pursue here. But for me, one particularly compelling part of the Chilean law that we should pay attention to in the U.S. is how the standards are consistent, and that the same foods that bear the front-of-pack warning labels are those that are restricted in schools and cannot be marketed to children. Looking for opportunities for similar types of harmonization across different areas of dietary guidance and policy within the U.S. moving forward would certainly help with consumer education, and I think would make sense in other ways. And one interesting thing to keep in mind when talking about the use of mandatory warning labels in a U.S. context is that there are some potentially binding limits on what the government can or can't compel food manufacturers to put on a food pack. Think of cigarette labels for a moment. We've long required that cigarette packages have the rather bland, plain text Surgeon General's warning that we're all familiar with seeing. But in the late 2000 aughts, the FDA proposed rolling out a series of graphic warning labels modeled, in part, on similar images used in other countries. And in that case, the effort was scrapped because of a widespread concern that requiring tobacco manufacturers to put a picture of a body in a morgue with a body tag on it, for example, is interpretive language that appeals to an emotional response, and that this would actually be a form of government-compelled speech that runs up against our First Amendment protections in a way that a scientifically-factual, text-only statement would not. While I personally don't know that the Chilean labels would be interpreted in the same way here, I'm quite certain that legal challenges would be raised to clarify this question in the U.S. context. So, it might be a little bit tougher to take some warning label approaches here in the United States than what we've seen enacted elsewhere.     Bios   Gabriela (Gabi) Fretes is an Associate Research Fellow in the Nutrition, Diets, and Health (NDH) Unit of the International Food Policy Research Institute. She received her PhD in Food and Nutrition Policies and Programs at the Friedman School of Nutrition Science and Policy, Tufts University, USA in 2022 and holds a Masters in Food and Nutrition with a concentration on Health Promotion and Prevention of Non-Communicable Diseases from the Institute of Nutrition and Food Technology, University of Chile. Her research interests are at the intersection of child obesity prevention, food policy and consumer behavior, and her doctoral thesis involved evaluation of a national food labeling and advertising policy designed to improve the healthfulness of the food environment and address the obesity epidemic in Chile, particularly among children. She has worked with a broad range of government, international organizations, academia, public and private sector stakeholders and decision-makers in Paraguay, Chile, and the United States of America.   Camila Corvalán is a surgeon, a Master in Public Health, and holds a PhD in Nutrition. She is the Director of the Center for Research in Food Environments and the Prevention of Chronic Diseases Associated with Nutrition (CIAPEC), at the Public Health Unit of the Institute of Nutrition and Food Technology (INTA) of the University of Chile. CIAPEC is dedicated to the population study of the early nutritional determinants of obesity and associated chronic diseases, particularly metabolic diseases and breast cancer. Their work focuses on carrying out longitudinal epidemiological studies (both observational and intervention) in stages considered critical for the appearance of these diseases, such as pregnancy, childhood, and adolescence, considering various determining factors in both the environment food (set of factors that define population feeding patterns) as individual. CIAPEC is a part of the international network INFORMAS for monitoring food environments, and also carries out policy evaluations such as the Chilean Labeling Law; CIAPEC works in coordination with several governmental bodies.   Sean Cash is an economist and associate professor of agriculture, food and environment at Tufts University. He conducts research both internationally and domestically on food, nutrition, agriculture and the environment. He is interested in the environmental impacts in food and beverage production, including projects on crop quality and climate change, consumer interest in production attributes of tea and coffee, and invasive species management. He also focuses on how food, nutrition, and environmental policies affect food consumption and choice, with specific interest in children's nutrition and consumer interest in environmental and nutritional attributes of food. He teaches courses in statistics, agricultural and environmental economics, and consumer behavior around food. He is currently Editor of the Canadian Journal of Agricultural Economics and on the editorial board of Agribusiness, and has served as the Chair of the Food Safety and Nutrition Section of the Agricultural and Applied Economics Association.  

With the widespread presence of artificial sweeteners in the food system, scientists and consumers want to know about their safety. Safety concerns have been expressed for years, and lots of research has been done, but relatively new on the scene is work examining the effect of sweeteners on the microbiome. This interview is part of a series on the impact of artificial sweeteners. Our guest today, Dr. Jotham Suez, is doing fascinating work on this topic. He's Assistant Professor of Molecular Microbiology and Immunology and the Public Health Johns Hopkins University. Interview Summary   So most everyone knows of the microbiome, but not everybody knows exactly what it is and how it works, so I'm hoping we might start with a quick overview of the microbiome. Could you help us with that?   Sure, so I would say there are three really important things to know about the microbiome. We know that there are trillions of microbes, bacteria, and viruses living in our body. What everyone should know is that most of the systems in our body require these microbes for their proper development and proper function throughout our lifespan, so without these microbes, our immune system, and even our brain, would not develop properly, and if the microbiome is perturbed, this can lead to development of various diseases. That is the first thing. Already this implies that the microbiome is amenable to change, which is actually something that is attractive facet about the microbiome. If we know that the microbiome is involved in the pathogenesis of various diseases, then we can use that to our advantage, and we can think of way to change this microbial community to help protect us against disease, or even treat diseases in which the microbiome plays a role in the pathogenesis. The third thing that we should all think about is that the microbiome is some sort of a fingerprint. Each one of us has a unique microbial community in their body, and we can use that person-to-person difference in the microbiome on one hand, to predict disease risk. This is because some people would harbor the microbes that make them prone to diseases. We can also use that to tailor various drugs or various diets, or various therapeutics, to that community, because we would be able to say, based on your microbiome, how you would respond to a certain therapy or a certain diet. Heterogeneity in the microbiome plays an important role in personalized medicine.   Thanks for helping establish how important the microbiome is, and also, how it can be affected in both positive and negative ways. So in that sense, what got you interested in the impact of artificial sweeteners on the microbiome?   Yes. I think it was the person-to-person heterogeneity, and how that can lead to differential responses to diets or therapeutics. Just like you said, there have been decades of studies on efficacy of artificial sweeteners or potential safety concerns about whether they are helping us lose weight, helping us maintain healthy blood glucose levels, or they are actually doing the opposite. The studies are really all over the place. You would see studies that support a beneficial impact and studies that demonstrate detrimental impact. We were wondering as we started this research, if it's possible that this heterogeneity in outcomes of the studies is related to heterogeneity of the microbiome. Is it possible that some people are negatively impacted and some people are positively impacted, whether this is related to the differences in their microbiome.   That's a fascinating area, and interesting to think that the same substance may have much different effects on people. So how have you gone about studying this yourself, and what have you found?   We started very naively. I started when I was still a PhD student. I went to the supermarket, I purchased sachets of the most common artificial sweeteners that are out there, and we added that to the drinking water of mice. We saw that mice drinking these artificial sweeteners developed glucose intolerance, meaning they had poorer response to a simple sugar, which is how you would predict or diagnose pre-diabetes or diabetes in the clinic, for humans. We were able to show for the first time that sweeteners can actually cause negative impact on the metabolic health of an animal. What was more interesting is that we saw that these sweeteners also changed the microbiome of the mice drinking the sweeteners. What we've done then is take the microbiome of the animals that were drinking sweetener and we transplanted these microbes into mice that don't have any microbiome of their own. Just by giving them the microbes of mice that were drinking sweeteners, these mice also had a poorer metabolic response. We were able to show for the first time that the impact of sweeteners on the microbiome can result in a negative impact on our metabolic health. After a lot of experiments in mice, where we proved beyond any doubt that mice should not drink artificial sweeteners, we were really wondering what would be the impact on humans.   We started a study in healthy individuals, so people that are not overweight and are without diabetes. We asked them to supplement their diet for two weeks with common artificial sweeteners, so sucralose, aspartame, saccharin, or one natural non-caloric sweetener stevia, and we followed up on glucose tolerance and also on their microbiome before, during, and after the exposure to the sweetener. We saw that two sweeteners, saccharine and sucralose, had a detrimental impact on their glucose tolerance. So just during two weeks of exposure to the sweetener, they had poorer responses to glucose. That would already put them on the path to potentially developing pre-diabetes and diabetes. We saw that all four sweeteners altered the microbiome. Again, when we took microbiomes of these people and transplanted them into germ-free mice we saw that the stronger the impact the sweetener had on your microbiome - that means that you would have a poorer metabolic response when you transplant these microbiomes into mice. This was really showing that there are person-to-person differences in the responses to sweeteners, and this depends on how much a microbiome is impacted by the sweetener.   That was amazing summary in a short time of really complex and fascinating science. It's interesting that some sweeteners are having a stronger effect than others, which I guess makes more sense, because they're not all chemically alike. Is it possible to know when you get an effect on something like glucose tolerance from the use of the sweeteners, whether the microbiome is the main mechanism, the only mechanism? How does it fit in there when you start thinking about the impact of sweeteners on something like the glucose tolerance?   That is a really great question, and I think the short answer would be that we don't know for sure. There have been multiple other groups that have been studying the impact of sweeteners on metabolic health or other parameters related to our health that have found fascinating mechanisms that are not related, or at least, not directly related to the microbiome. So for sure, sweeteners can have a broad impact on our body, not just for their impact on the microbiome, but what we are seeing, actually, is that's the impact that they have on the microbiome is sufficient to produce detrimental impact on metabolic health without any other measurable impacts, at least, in our studies.   Many, many people have been using these artificial sweeteners in one form or another for many, many years, and in some cases, they're introduced into the food supply in ways that people may not even be aware of. Is there any way of knowing what happens if animals or humans have used these for a long period of time and they stop? Does whatever the impact on the microbiome reverse itself?   That's a fascinating question. In the short term, that is something that we have measured in our studies, and others have done similar works in animal models. In a study like what we have done, which is two weeks of exposure, then one week of follow-up, you see some reversion of the microbiome to what it was before the exposure to the sweetener. But we should say that these individuals were recruited to the study precisely because they're habitually not drinking artificial sweeteners, so their body saw sweeteners potentially for the first time. So then if they immediately stopped after two weeks, in that scenario, we can say that the microbiome reverts. What happens after years of exposure to sweeteners, that's a study that we're definitely interested in doing, or I would be really happy to see the results if some is already doing such a study, but I am not aware of long-term studies where people just stopped taking sweeteners and then their microbiome was profiled.   My mind is sort of firing with ideas of ways to study that question, but it's heartening to know that at least in the short term, at least some of the whatever damage is done starts to revert. That's very good news for people who have been using these products who choose to stop them for one reason or another, there may be a benefit to the microbiome. Let me ask about children. So many parents, they're concerned about the effect that the sweeteners might have on their children. Is anything known about this?   Yes, I think this is a good point in the conversation to talk about the various types of evidence that we have about the detrimental impact of sweeteners. If we look at associative studies, most of these studies would find some sort of association between drinking artificial sweeteners and a negative impact on weight or on diabetes risk. So the associative studies are, for sure, pointing to a negative impact, but they don't provide evidence that the sweeteners are causing these negative impacts. So they might be a result of, you know, the changes in weight or the risk of diabetes rather than the cause. And then when you go to studies that actually provide causality, so these would be, for example, randomized controlled trials when you give the individual the sweetener then see what happens to their metabolic health, these types of studies are all over the place in terms of benefit versus risk, both in adults and in children. So unfortunately, there is no good answer to that question. There are studies that show a risk, but even studies that show a benefit.   Even if there is risk from the artificial sweetener, some people may feel that the benefit, in terms of weight control, is more important, and they might say, "Well, I'm willing to accept the risk because of the benefit," but we've heard from others that whether these products actually help people control their weight is in question as well. What do you think about that topic?   Yes, so what you would do when you have all of these studies that show even opposing results, and you try to find the truth, you would do a meta-analysis. When you perform meta-analysis on specifically the question of impact on weight, you find a very modest beneficial impact on weight. And even then, the quality of the evidence for that impact are low. Even if there is a benefit, it's very mild, and the evidence for such a benefit are not very strong. I think that's why organizations such as the World Health Organization have recently said that this may not be the best strategy for assisting individuals to lose weight.   You mentioned that the two compounds that had the strongest effect on the microbiome were saccharin and sucralose. Is that correct?   In our study, yes.   So saccharin, I'm not sure how much that's used in the food supply still. It may be there, but it's been around forever. Maybe I'm wrong, but I figure that it's been displaced by lots of newer advances. But sucralose, which I think is marketed under the brand named Splenda, is a much more recent development in the field. It's interesting that that's having a negative effect too. So do you think that there's reason to believe that those two would be substances to avoid?   I would say that you would never want to make public health decisions based on one study. I would say that that goes both ways, I think. I wouldn't advise avoiding saccharine just based on one study, and I wouldn't say that aspartame and stevia are safe just based on one study. I would say that others have found negative impacts for aspartame and for stevia that we have not seen very strongly in our study, whereas others have found both negative and neutral, or even beneficial effects for sucralose in other studies. So I would not make recommendations based on just our own study, but considering everything that is out there, I would say that all four sweeteners that we studied, and others, including Ace K, that we have not studied in a recent human study could pose a risk for some individuals. Unfortunately, right now, we don't have any good tools of predicting who would be those individuals, so it's a question of whether people should take that risk or not.   Thank you for being appropriately cautious with the result, because as you said, the work is relatively recent, but why I'm really happy you're working on this topic. So summing this all up, what do you think is most important for people to know?   I think, at this point in the research, and just recently, another group provided really interesting evidence about a different sugar substitute, erythritol, also posing a risk for cardiovascular disease, at this point in the research of artificial sweeteners and sugar substitutes, I think we cannot say that these substances are innocuous. They can pose a risk for at least some individuals, and we and others are definitely working hard on being able to help people know whether or not they are in those risk groups. But then the question is what can people do? I think what people should definitely not do is switch back to sugar. I think that if the evidence for the impact of artificial sweeteners are still something that requires further research. I think that the detrimental impacts of added caloric sugars in our diet, in our beverages, are beyond doubt linked to detrimental impacts on our metabolic health. So people should not switch back from diet soda to regular soda, that's for sure. But we and the industry alike should find ways of reducing the intake of sweeteners, and both caloric and non-caloric sweeteners in our diet to levels that hopefully don't pose as great a risk as what we are currently consuming.   Bio   Dr. Jotham Suez is a Feinstone Assistant Professor at the Johns Hopkins Bloomberg School of Public Health. Dr. Suez's work on non-nutritive sweeteners was instrumental in understanding how these popular food additives can counterintuitively disrupt glycemic control. During his graduate work at the Weizmann Institute, he demonstrated that sweeteners are not inert and can alter the gut microbiome, and causally linked those impacts to impaired glucose tolerance. He further showed that in humans, the microbiome mediates individualized responses to sweeteners, potentially underlying the conflicting literature on their impacts. Similarly, Dr. Suez's research on probiotics offers an opportunity to resolve the contradictory literature on their efficacy. His work highlighted the microbiome's importance in modulating probiotics colonization and downstream impacts. Inspired by these discoveries, Dr. Suez is fascinated by the potential of harnessing microbiome heterogeneity in precision medicine and personalized nutrition. In 2020, Dr. Suez received the NIH Director's Early Independence Award.  

Today we're speaking with Roland McReynolds, Executive Director of the Carolina Farm Stewardship Association which is a member-based farmer-driven, non-profit organization based in Pittsboro, North Carolina, that helps farmers and consumers in both North and South Carolina grow and eat local organic food. Interview Summary   So why don't we begin with this. Can you help listeners understand what the Carolina Farm Stewardship Association does?   So our vision is a sustainable regional food system that is good for all consumers, good for farmers, good for farmworkers, and good for our ecosystems. So to achieve that vision, we work with farmers and with communities to advocate, educate, and build connections that support sustainable food systems in the Carolinas, centered on local foods and organic agriculture. We do that by working and consulting directly with farmers to help them implement organic practices in their operations and to help them expand their market opportunities. We work with food hubs and other sorts of food businesses to strengthen their operations so that they can become reliable market outlets for small farms and improve their competitiveness and ability to connect with values-driven buyers. We provide education and training both for farmers and the public. For instance, we host the largest organic farming and food system conference in the Southeast which this year is actually taking place in downtown Durham, November 6 through 8, 2022. We also run a farm incubator facility in Concord, North Carolina to help new organic farmers learn the trade and become successful in moving into organic farming as a career. We do consumer outreach, such as our Piedmont Farm Tour event here in the Piedmont Triangle area in North Carolina and K-12 agriculture education. We do a lot of advocacy educating state and federal policy makers on the needs and concerns of sustainable farmers. And, training people at the local level on how they can be effective advocates for healthy and just food systems.   Thank you for that description in this sort of remarkably broad portfolio you have. I can imagine how busy you folks are! But let me ask a question of kind of a national scope. Are there other organizations like this around the country, and is there a coalition of such groups?   Absolutely. Many states have sister organizations, like Carolina Farm Stewardship Association, serving their communities and their regions. One national umbrella group that we're a part of is the National Sustainable Agriculture Coalition, which acts as a lobbying voice for our sector in Washington DC. Their members span all the way across the country. So similar types of organizations that we work with are in states everywhere, like the Northeast Organic Farmers Association in New England, Community Alliance for Family Farms in California, and everywhere in between.   So let's go back in time and speak about how the association got started. So what were its origins, why did people think there was a need for this, and who are the members?   Essentially, it was a group of organic farmers and gardeners who got together back in 1979 seeking to practice organic farming, and to gain opportunities to learn about how to grow organically. And who wanted to see a food system that was re-centered on communities and relationships and shifted away from a commodity mindset of the cheapest food grown using practices that were focused on extraction from the natural world. These were farmers and gardeners who wanted to work with the natural world and work with their neighbors to create a different vision for a food system. This is the late 1970s, and this was during the "Get Big or Get Out" mindset in agriculture. In fact, existing agricultural institutions, universities, companies, were really actively hostile to organic. It was really to create that peer-to-peer learning opportunity for farmers across North and South Carolina that CFSA originally began. Over the years, the initial project of the organization actually came to be an organic certification agency. Back before there was the green organic seal that we have in the grocery stores today, the organic label was something that was locally defined. There wasn't a national program. So these farmers got together and decided and collectively created organic standards for helping them to manage their farms in a way that was beneficial to the environment that promoted healthy living soils. And over time, as we've expanded, and as the movement has expanded, those farmers recognized the need for policy advocacy and policy change to promote more sustainable food and farming systems, and to expand our services so that we can encourage and promote new farmers to get into organic agriculture and local food.   Now that you explained the origins of the organization, I was first going to say it was the beginnings of a trend for people and farmers to become more in touch with one another through things like farmer's markets and local produce programs and farm-to-school programs, things like that. But it wasn't a new trend. It was sort of the restoration of what existed before when people were more in touch with the farmers who grew their foods, and that connection between farmers and their communities is a really interesting one. And I'd love to hear your thoughts on the role that farmers can play in addressing economic and social justice issues in their communities.   Absolutely. A really great example of how the sustainable agriculture and sustainable farming community in the Carolinas is doing just that today is our FarmsSHARE Program which was developed as a COVID response by Carolina Farm Stewardship Association back in 2020. Initially, we saw with the pandemic and the public health controls that were being put in place, saw restaurants closing and especially those farm-to-table restaurants that were buying food from small local farms in our region and across the country. So those farmers all of the sudden lost a market, and they already had crops in the ground ready to sell, and the restaurants were laying off their workers. And, you know, this predominantly is people working in the kitchens and in the service industry who tend to more likely come from oppressed backgrounds, and they didn't have money because their jobs were getting cut off. So our FarmsSHARE program initially was created to provide CSA-style boxes from those small farms to those restaurant workers who were unemployed, or underemployed, as a result of the pandemic. Thanks to some very generous funding from the Blue Cross Blue Shield Foundation of North Carolina, CFSA was able to buy that food from those small farms. They then worked with local food hubs to have it packed, and then the food hubs delivered the food to the restaurants that they used to sell to so that the workers could have this free, fresh, healthy food. As the pandemic has evolved and revealed to a wider population, the realities of food insecurity in our communities across North and South Carolina, FarmsSHARE evolved to address people throughout society who are in need of fresh, healthy food. So the way FarmsSHARE works right now is that we provide funding to food hubs for them to purchase food directly from small farms, package that up, again, into CSA-style, (Community Supported Agriculture) boxes. And then take that to food pantries in their own communities and senior centers in their own communities so that small farms are, through this program, feeding people in need in their backyards. This is a great example of what happens when we marshal many small farms to work together to address the injustices in the food system in their own communities, and bring healthy food made in harmony with nature to the people that deserve it.   Well, it's a great example of ingenuity. It's a great example of the resilience of a local food system and how people can come together in times of crisis, and the FarmsSHARE program you talked about is really interesting. Do you think that the lessons have been learned about how these food systems can be resilient so if something like this happens again, let's hope it doesn't, but if it does, that we'll be able to respond even more quickly and effectively?   I think we have an opportunity to help people learn that lesson. I mean, there's no doubt we have seen examples of fragility of the national and international food systems as a result of COVID, and we've seen examples of local food systems being resilient. As a professor and instructor, you probably appreciate that learning doesn't just happen from experiencing it once. We have to keep pushing and keep sharing those examples. This is really where the role of policy becomes vital in terms of ensuring that our society learns these lessons. The Farm Bill is coming up, which is the massive five-year legislation that Congress brings about every few years that guides food and agriculture policy in this country. That is a crucial opportunity for advocates of resiliency in our food system to make sure that these lessons actually get ensconced in policy. That policies that direct and incense the production and distribution of food in this country are built to be resilient instead of to be commodified.   Well, so let's talk about the Farm Bill. We'll turn our attention a little bit from the local picture to the national one. So this is an enormous and enormously complex piece of legislation and, as you said, it's coming up for renewal. So what do you think the legislation can do to help support local and regional food systems, and what do you think the policy reforms might be for the 2023 Farm Bill?   It really is a crucial opportunity, and one of the places that can start is in food procurement policies within USDA programs. So when it comes to food purchasing that the government does for relief to address food insecurity, the primary metric for making those purchases, is how cheap is the food? We need to change that mindset. We need to change policy to allow for these systems to prioritize community development and supporting farmers as well as supporting communities. So, for instance, there is a proposed bill that's out there in Congress right now, the Fresh Produce Procurement Reform Act, that is an example of policy that we'd like to see incorporated into the next Farm Bill that would lower the barriers for small farms to participate in these feeding programs. And would allow the agencies that run these programs to make decisions based, not just on getting the cheapest possible food and calories for people who need it, but to actually allow them to get fresh and healthy food and do it in a way that builds community instead of extracts from communities. That's a crucial area of reform. Incenting, agroecological and conservation practices, and promoting more research on organic practices is also something that is a critical opportunity in this upcoming farm bill. There is so much that farmers do that is shaped by the policies that the farm bill puts out. The Farm Bill, as it exists right now, eliminates most of the risk for very large farms to just grow corn and soybeans, and to not worry about the environments. Changing those incentive structures, making it possible, and in fact, desirable for farmers to work in harmony with nature as a primary focus and as a primary benefit of their operations has to be a part of the kind of reform that's needed.   Bio   Roland McReynolds has served since 2007 as the Executive Director of the Carolina Farm Stewardship Association (CFSA), a member-based, farmer-driven non-profit organization based in Pittsboro, NC that helps farmers and consumers in the North and South Carolina grow and eat local organic food.  He is an attorney, receiving BA and BS degrees from the University of Missouri-Columbia, and his JD from the UNC-Chapel Hill School of Law.  Roland directs CFSA's programs and policy advocacy work at the state and federal level, and has served on the USDA's Fruit & Vegetable Industry Advisory Committee; the Policy Committee of the Organic Farmers Association; the National Sustainable Agriculture Coalition's Organizational Council; and the Advisory Boards for the North Carolina A&T State University College of Agriculture and Environmental Science and the North Carolina State University Department of Crop and Soil Science; among other boards and committees.  Carolina Farm Stewardship Association is the oldest and largest organic farmers organization in the Southeast. CFSA hosts educational conferences and events on sustainable agriculture and local food systems; provides training and direct technical assistance to local organic farmers; runs a training farm for new organic growers in Concord, NC; coaches food councils on effective policy advocacy; and represents organic and local food systems stakeholders with state and federal legislators and agencies. In response to COVID, CFSA has been operating a program called FarmsSHARE, a CSA-style food box program that addresses food insecurity in the Carolinas by purchasing food from small farms at a fair price and distributing that food to people in need through a statewide network of community-based food hubs. For more information about CFSA, visit www.carolinafarmstewards.org.  

What can be done to reverse racialized marketing of unhealthy foods to Black Americans? What if healthy eating could be seen as a radical act, or even as a form of Black activism and liberation? Today, we're talking about these issues with Dr. Shiriki Kumanyika about a new campaign called Operation Good Food and Beverages. This is an advocacy movement developed by and for Black youth who want to reclaim healthy food as part of Black lives. Shiriki is an emeritus professor of biostatistics and epidemiology at the Perelman School of Medicine at the University of Pennsylvania, and research professor at the Drexel University Dornsife School of Public Health. Interview Summary   I long admired the work you've done on food and beverage marketing, particularly around the issues of targeted marketing. And then still, you do even more worth admiring and along comes this new campaign that you call Operation Good Food and Beverages. Can you tell us about it?   This campaign is really the culmination of my efforts to do something about the marketing of unhealthy foods in general. But to Black communities in particular, I think first and foremost, it's a call to action to make healthier foods and beverages more available and promoted in Black communities, especially Black youth. It has some educational or motivational elements to it because the call to action is contextualized in a broader message about good food. And, how young people like to have good food, how it makes them feel, and that the messages are in one place on the website. We are more than food companies think we are. You know we're much more than that. So it's a positive campaign. The main elements: our website with various resources, and two social media accounts. One on Instagram and one on TikTok. The main audience is youth, but we also hope to reach parents and others in Black communities Including celebrities and allies of Black communities and anyone who really sees this as an opportunity to send a positive, but somewhat different message to the food sector about marketing of unhealthy foods and beverages.   So before we dive in and learn a little bit more about the nuts and bolts of this, why did you decide to focus on marketing to youth, and in particular, on Black youth specifically?   Well, there are a lot of reasons for choosing youth. I think the most positive reason is the increasing role of youth in various social justice movements, and in raising their voice. There's a lot of energy in the generation that we were targeting here: Generation Z. Those are sort of late teenagers and maybe early college age. So that's one reason. Youth are really great messengers, I think, for a positive message that relates to them and relates to their communities in general. The reason, in terms of food marketing, is that it is kind of a perfect storm. There's a whole body of work that talks about the sensitivity in the adolescent years to identity formation issues, role models that they see, and perhaps a particular responsiveness to ads in Black youth. Seeing themselves positively represented, perhaps and helping in that way with identity formation, but linking this to some of these unhealthy products that they see in the media. So there are really a lot of reasons that Black celebrities are really prominent among people marketing these foods and beverages. And so we thought, considering that these diseases really start at a young age, then we would work with youth in terms of prolonging their lives and keeping their risk factors down.   That certainly makes sense. So tell us what youth will encounter when they interact with this program. What does the program consist of?   So the program consists of a website as the sort of main home base. It's called Operation Good FB, and it is meant to create a very positive picture of foods and beverages that youth might want. As well as mentioning what the problem is, but not dwelling on the negatives of the problem and the negatives of the associated disease burdens. Because we really want it to be very uplifting and positive experience. The social media sites then have similar posts. The youth posts on those sites messages about good food and beverages. And the first thing you see is an opportunity to click and sign a petition. That is one of our key action items. It's directed to the National Restaurant Association. It urges the National Restaurant Association to encourage their members to make healthier options available on the main menus that would appeal to teens. This is building on the progress they've made with healthy options for younger kids through the Kids LiveWell program. So those are the main elements. There are different things that people can do in terms of using social media and so forth, but it's the website, two social media accounts. And the petition is critical for showing that there's a broad base of support for what we're asking.   Oh the petition is a really interesting idea. Would you envision, at some point, expanding it to other parts of the food industry beyond the Restaurant Association?   At this point, I can't say because the petition is asking for the National Restaurant Association to meet with the Council on Black Health, which is our organization that is sponsoring Operation Good Food and Beverages. For that particular association, it's relatively clear what the ask is. It's very concrete. They have a lot of members. Those members have menus that directly relate to children and youth. Because we know through some CDC data about fast foods on any given day that one in every three children is eating at a fast food restaurant. So it's very concrete. For the packaged food industry, which is also relevant, the ask is not as clear. I think we're interested in seeing progress in the other types of foods, but they're not as clearly targeted to youth. So if there's a way to expand it, I would love to do that. But right now, to get action and to season success, we're focusing on the National Restaurant Association and things that they can do. And hopefully they'll be inclined to do.   It makes sense to start with the restaurant sector. It'll be interesting to see over time if the petition has the effect that you hope it does whether other parts of the industry could be brought into the fold as well. So what do you hope will be different if you're successful? What will change?   Well, I have high hopes. I think at minimum, a new conversation that would be picked up widely in the public health and social justice communities, and in the broader consumer communities, this it's not an issue that's talked about a lot in the consumer community and the public health. Messaging, although powerful and well-backed by evidence about the need for change, has just not been that effective in creating changes that would affect a broader audience. So some progress focused on the younger children.   I hope that we could have a new conversation and one that's more positive than we've seen before. Because we think that people respond to positivity. And so if you're always sort of bashing and saying, "This are the problems in the Black community and this is what you're doing wrong," we don't think that that's necessarily going to be effective. So I hope that we can shift the conversation somewhat to what we do want to see - to the solution as opposed to continually emphasizing only the problem. And ultimately, I would like to see what we're asking for. We would like to see the good foods promoted. They're a small part of advertising budgets overall, as I'm sure you know. We would like to see this balance really shift as a part of expressed demand, but also as a part of understanding in the industry that the current practices are really not representing what consumers want to the level that they could. So I think that's what we'd like to see. You know, changing the world is a big deal, but if we can get it started and other people pick it up, maybe some of the celebrities will pick it up and use their celebrity power, then we can have a change in the food marketing conversation and eventually in the food marketing.   Well, you could only imagine the boost that would occur to this if some celebrities got involved. Another question I had as I was doing the introduction for this, we mentioned that Black youth had been involved in developing this program. Can you explain how that process unfolded and how that was important in determining the final content?   Well, the youth involvement is critical. We're working with youth from a group cohort, Smiles MD, which is in Baltimore, Maryland, and it's associated with Johns Hopkins University. And our sponsor was the Bloomberg Initiative at Johns Hopkins. So what they did, they set us straight from the very beginning about what they wanted to see in food and what their generation likes to see in the media. They like positive representations. They have very creative ideas about how to think about this. And as we go forward we are hoping that they can really connect with a larger network with youth organizations holding some web interactive sessions on social media and connecting directly with other youth who can spread the word within this generation even more broadly.   So they've been key because even though I've been studying this issue for a long time, I'm far from Gen Z, and we want to reach that group. And they do see things differently. The social media component is definitely something that they are looking at much more than the traditional media, for example.   Oh, I could only imagine the ingenuity of it must have come from youth getting so engaged in this. So let me ask you one final question. How can people participate if they want to join in and be part of this?   Well, there are many different ways people can participate. We would like everyone to start with the website and take a look at the petition, sign it if they're on board with the ask, which are very positive, use the tips and recipes themselves, but then help to spread the word using social media kit that's downloadable from the website. Spread the word among their networks if they are in touch with youth organizations who could, as a group, really broaden the campaign, post on the social media and so forth, show that there are thousands and thousands and thousands of people who think that the marketing mix could change.   Bio:   Shiriki Kumanyika, PhD, MPH, MS is a Research Professor in the Department of Community Health & Prevention at the Drexel University Dornsife School of Public Health and Professor Emerita of Epidemiology at the University of Pennsylvania. She holds a BA in Liberal Arts from Syracuse University, an MS in Social Work from Columbia University, a PhD in Human Nutrition from Cornell University, and a Master of Public Health from Johns Hopkins University. Over more than three decades, Dr. Kumanyika has led or collaborated on research related to obesity, sodium intake, and other aspects of diet and lifestyle and chronic disease risk reduction. Several of her studies have evaluated behavioral interventions to facilitate healthy eating and weight control in Black children or adults in clinical or community-based settings. Her research during the past 15 years has focused particularly on identifying ways to combat the effects of racialized, targeted marketing of unhealthy foods and beverages on food-related attitudes and practices of Black Americans.  Dr. Kumanyika is the founding chair of the Council on Black Health, a research and action network dedicated to improving Black Health nationwide. She is a past president of the American Public Health Association and a member of the National Academy of Medicine.    

During the early days of the COVID-19 pandemic in 2020, much of the US was in lockdown. Many people had lost jobs or could not work from home during that time and struggled to pay their bills. Shortages of food and other basic necessities were common. Many people needed help during this time. Charitably-funded volunteer staff organizations like soup kitchens and food pantries suddenly found themselves on the front line of a massive ongoing food relief emergency. Many of them did heroic work. We're speaking today with the co-authors of a new report titled, "The Impact of the COVID-19 Pandemic on US Hunger Relief Organizations, from August and November of 2020." Gizem Templeton is a researcher at Duke University's World Food Policy Center. Alison Cohen, formerly of WhyHunger, is a research consultant on the project. And Suzanne Babb is the director of US programs at WhyHunger. Interview Summary   So Gizem, let's begin with you. Can you tell our listeners about the survey itself and what WhyHunger hoped to accomplish through this work?   Gizem - Sure, Kelly. So as a research partner for WhyHunger, we wanted to survey hunger relief organizations, which are food banks, food pantries, soup kitchens, as well as hunger advocacy organizations during the pandemic in the summer of 2020. Our goals were twofold. First, we wanted to document what was happening in terms of pandemic impact and response. And second, we were interested to see what programmatic policy and food system recommendations they had for the future. All in all, over 240 hunger relief organizations from 39 states responded to our survey.   It was important to understand the impact on hunger relief organizations because these organizations are mostly dependent on charity donations of cash and food. Their operating budgets change from year to year. And, they're staffed largely by volunteers who tend to be older individuals. So as you can imagine, the COVID-19 pandemic created a range of daunting challenges for them.   You may probably recall the many media stories with photos of long lines of people trying to get food during the summer of 2020. The hunger relief organizations in our survey said that demand for food and other services increased significantly. We heard that people who used to donate money were coming in to get food themselves. And also, that many families were struggling simultaneously with job losses, housing issues, and reduced access to food. Hunger relief organizations did everything they could to stay open. And we saw a lot of innovation to meet the demand, in this survey.   I mean, there is no question that hunger relief organizations gave their all for our society during the pandemic, but in their own words, they also questioned the country's dependence on charitable donations to keep people fed. And survey responses highlight a need to strengthen the national social safety net and to focus on the root causes of hunger.   So Gizem, how did the hunger relief organizations grapple with these tremendous challenges during the pandemic?   Gizem - Yes, so first, all but two of the organizations who responded to our survey were able to remain open. But all of them had to make big changes very quickly to keep up with an almost overwhelming demand for food and new safety practices as more was learned about COVID. And we saw shifts to curbside pickup of food, some home delivery, and a few organizations were even able to offer client transportation for housebound individuals. Some hunger relief organizations made a shift to online ordering.   I would say the biggest challenge they faced was the loss of volunteers due to COVID risk. And they had to suspend some programming as a result of that. Many surveyed organizations said some of their volunteers and staff contracted the virus during this time. Another challenge was not enough refrigeration space for perishable food and storage for shelf stable food as the volume of food coming in increased to meet the demand.   And a big challenge, I would say, the organizations at times struggle with a lack of communication and coordination from the government that would've allowed them to prepare for changes to regulations, safety protocols, and federally sponsored programs like the Farmers to Families Food Boxes.   In terms of what helped them meet the demand, I would say philanthropic funding was key. Charitable funding for emergency food surged during this time and partnerships within and outside of the hunger relief world and increased local coordination were also big contributors to success.   It is clear that the hunger relief organizations did incredible work to support our society during this chaotic time. But we have to ask ourselves, does it make sense in a country as wealthy as ours that so many people had to turn to charity in order to have enough food?   So Alison, in your view, what were the most surprising and the most troubling and even the most hopeful things that you uncovered in the survey?   Alison - Well, I think the survey uncovered both troubling and hopeful things given that the entire emergency food system was thrown practically overnight into crisis mode. Because of the pandemic, we witnessed every single hunger relief organization pushed to its limits. And the ways in which the system was taxed during this time is not surprising given that for many working families, the local food bank has become a kind of free grocery store that helps to plug the holes in household finances year round.   For many decades now, the rate of food insecurity has not fallen below 11%. Food insecurity is, unfortunately, a way of life for far too many households. And as Gizem said, a majority saw an increase in need.   What we need to pay attention to is the way in which this increase in need was confounded by other issues that for many, were not experienced by or visible to hunger relief organizations before the pandemic. For instance, these organizations struggled with the government's response to the pandemic, particularly the inconsistency and unpredictability of the response. The government, of course, was dealing with this magnitude of crisis for the first time itself. More than 70% of HROs said that in order to fill the gaps in government support, they turned to their own forms of communication and coordination with funders, local farmers and growers and other stakeholders, other community organizations.   This survey was unique in that we queried first responders, so to speak, to a food security crisis unlike anything we've experienced in the US at that scale. And our findings in the survey add to the reports and stories in the media, those that we all heard and saw, of the miles long lines of cars waiting in parking lots to receive food and the millions of people who found themselves needing a food bank for the very first time in their lives. And all of that exposed how inadequately we, as a society, are addressing the economic precarity of a majority of American households. And therefore, how in sufficiently we are working to end hunger in food insecurity in one of the wealthiest countries in the world.   But Kelly, it wasn't all doom and gloom. There was a lot of hope, I think, that came through in the survey. And what I found particularly hopeful is that hunger relief organizations overwhelmingly embrace the both end of their missions. That is to ensure that folks who need it get healthy food now and to ultimately end food insecurity. And based on their responses, they have a multifaceted understanding of what it will take to do both and what the role in it should be. And I think that's an incredibly hopeful point and something we should pay attention to.   Well above 60% of hunger relief organizations identified dependence on volunteer staff, dependence on individual and corporate donations as issues to be addressed. They also cited lack of government support and solutions to address the root causes of hunger such as unaffordability of healthy food, low wage jobs, unresilient food supply chains, and they called out as problematic the persistence of inequitable access to healthy food is a manifestation of structural racism in the food system.   But their clarity on where the deficiencies are in the system doesn't end there. They have a strong vision for what they want to see happen and their role in it. These organizations are calling for increased sustainable and more flexible funding so they can get healthy food to people in the most dignified way possible. They're also calling for a stronger social safety net. They want to see the increases that were legislated during the pandemic become permanent features of the social safety net, including universal free school meals. And they're also advocating for snap changes such as more flexibility and broader access. And they're calling for the descaling of government food nutrition programs. Instead, advocating for programs that address the intersections of food security, affordable housing, mental health, living wages, and childcare among other issues.   One respondent wrote in the following response, which was repeated by other respondents in their right end responses as well: "People need living incomes, ones that make it possible to provide both food and shelter. Emergency food network should not be used to prop up an inadequate system of income support."   You know, Allison, as I'm listening to you, it's so clear that this was an enormous challenge with so many implications for looking back on what was done and thinking about the future and what might be done. So it's really helpful to have you talk about some of the permanent changes that could help for us stall or even avoid such a terrible crisis should something like this happen again.   So, Suzanne, let me ask you. The report presents the perspective that the US relies too much on charitable food, but if there's philanthropic support out there for the charitable food system, why is this such a problem?   Suzanne - Well, there are couple of reasons for that. I think, firstly, the charitable food system cannot meet the need. I think then it's important to think about what the charitable food system is based on, and although it has the best of intentions and is trying to fill a need, the majority of the system props up this dysfunctional system that relies on corporate waste. And far too often, these corporate donations are highly processed, filled with high fructose corn syrup, and are lacking in nutrition. And this helps to contribute to increased rates of chronic disease like diabetes and heart disease that disproportionately impact low income and BIPOC people. Also, the corporations that benefit from these tax write-offs in the process are notoriously the low wage employers who don't pay people enough money and whose staff rely on food stamps and charitable food to feed their own families.   Another reason is that the right to healthy and nutritious food is a basic human right and governments bear responsibility to their citizens to fulfill these human rights. But the US has slowly reduced its role in fulfilling that responsibility, and instead have been putting it in the hands of charitable organizations that have been vulnerable, always relying on donations and volunteers. And this is just not a sustainable system.   The US hasn't codified the right to food federally. There's one state, the state of Maine that has done so in their constitution in 2021. And there are other states that are organizing and strategizing to do the same. I think, lastly, it's important to remember that hunger is a symptom of poverty and poverty is a created condition. And the government has played a role in creating this condition and has a responsibility to be a part of the solution.   Thanks, Suzanne. So Alison, let me ask you one final question. The report offers up quite a wide range of recommendations for hunger relief organizations, also for philanthropy and for the federal government. Can you provide examples of organizations who are already implementing some of the recommendations? Could you talk about these and the opportunities that you see for a sustainable change?   Alison - Yes, yes, I'd love to. And I think that's a really important part of the report and there's much more in the report than I can say here during the podcast. So I would encourage folks to really take a look at the report, to hear more details, and to learn about very specific organizations and actions and activities that are happening.   So first, as Suzanne mentioned, yes, there's a historical over-reliance on the charitable food system and that has gotten out of balance. Hunger relief organizations, philanthropy, and the government all have a role to play in correcting that imbalance. Some 50 years ago, these organizations were designed to be temporary and crisis related, but what's emerged is a system that continues to need more and more bricks and mortar to mediate what has become a stagnant and alarming rate of food insecurity. And as we see in the results of the survey, many hunger relief organizations are expanding their strategies to include helping clients get access to government nutrition programs and policy and advocacy to improve federal nutrition programs. And a smaller, but I think growing subset of these organizations are beginning to address root causes of food insecurity such as low wages, poor working conditions, structural racism is a part of their mission.   For example there's a soup kitchen called Neighbors Together that has been operating in Brooklyn, New York for more than 30 years. About 10 or so years ago, they began engaging clients in determining their own advocacy agendas through what they called their community action program. Their participants, all of whom are patrons of the soup kitchen, identified insufficient wages and barriers to safe and affordable housing as primary reasons they required ongoing food assistance. So they organized others in their neighborhood and are currently advocating with the city of New York and the state of New York to implement policies that address housing and wages.   And in Washington State, the state's largest independent hunger relief agency known as Northwest Harvest is working to shift public opinion and change policies and practices that perpetuate hunger, poverty, and disparities while advocating for a right to food framing for statewide policies. They're one of the states that is really engaged in hoping to amend their constitution to include the right to food as Suzanne mentioned earlier.   And one last example, and again, the report contains many others, is the Black Church Food Security Network. Their mission is to ensure food security in Black communities by addressing racial and economic injustices. And they do this by co-creating sustainable local food systems in partnership with Black churches, Black farmers, and Black business owners. It's really remarkable.   So as the COVID-19 crisis continues to reshape public life around the globe, it's not over yet, unfortunately. The results of this survey strongly support the fact that we have an opportunity to organize and protect everyone's most basic human rights, nutritious food. And really, not just in response to COVID-19, but as a springboard to a social and political economy that puts people and planet first.   Bios   Gizem Templeton is a Research Associate at the World Food Policy Center at Duke University's Sanford School of Public Policy. She earned her PhD in Food Science and Human Nutrition from the University of Illinois at Urbana-Champaign. Her dissertation focused on the use of nanotechnology in peanut allergen and acrylamide detection while utilizing a biodegradable corn-based sensor platform. She is a native of Turkey and has been living in the States since 2011. Alison Cohen is a former Senior Director of Programs at WhyHunger.org. She has more than thirty years of experience supporting grassroots-led organizations in rural and urban communities around the world in strengthening social movements that address the root causes of hunger. She is currently coordinating a process to build a national movement for the right to food. She holds a master's degree in sociology from Virginia Tech. Suzanne Babb is Senior Co-director of U.S. programs at WhyHunger.org. She develops and oversees the implementation of WhyHunger's domestic strategies: Transforming the Emergency Food System, Black Food Sovereignty and Labor and Economic Justice. Suzanne helps to convene and support regional and national networks and alliances of emergency food organizations working to ensure the right to food by addressing the systemic inequities resulting in hunger and poverty. Additionally, Suzanne supports the growth of BIPOC led food sovereignty organizations, networks and alliances by mobilizing resources and providing technical support to aid in the creation of legislation, infrastructure and institutional structures grounded in equity and justice. Originally from Montreal, Quebec, Canada Suzanne has many years of experience working on community development

Today, we're talking to Dr. Jasmine Ratliff, who goes by Dr. Jas, and is an applied food systems research and policy specialist, and co-executive director of the National Black Food and Justice Alliance. She believes that your zip code should not determine your life expectancy and that building relationships are essential to creating a sustainable and just food system. Interview Summary   So let's begin with this. Could you tell our listeners a little bit about The National Black Food and Justice Alliance and some about your work there?   Yes. The National Black Food and Justice Alliance is a coalition of organizations. So we're not just one organizations. We represent multiple others, about 50 now, and we are committed to building Black leadership and Black food sovereignty.   Those are really important goals, and not easy ones to reach for sure. So let's dig in a little bit about how you go about doing that. Let's start with kind of your vision. How do you envision food justice and how do you think about the term food sovereignty?   I work at the Alliance. And at the National Black Food and Justice Alliance, we focus on Black food sovereignty and self-determining food economies, and specifically land justice. And we approach these through a lens of healing and organizing and resistance against anti-Blackness. And all of the work that we do is in pursuit of food justice. So I have a couple definitions. Founding executive director Dara Cooper defined food justice as a process whereby communities most impacted and exploited by our current corporate-controlled, extractive agricultural system shift power to reshape, redefine, and provide indigenous, community-based solutions to accessing and controlling food. And that includes the means to produce food that it is humanizing, fair, healthy, accessible, racially equitable, environmentally sound, and just. That's how I feel about food justice and it leads us right into food sovereignty. So I know you mentioned it's an overall long goal, and we borrow this one from La Via Campesina, but food sovereignty is the right for peoples to define their own food and agricultural systems, instead of food being subject to international market forces - as we all know food is so globalized. So sovereignty is absolutely our ultimate goal and it can't be achieved without confronting actual governance. So we work to ensure that Black people not only have the right, but the ability to control our food.   It really helps to have those definitions. And let's talk just a little bit more about this. So you talked about decision making, needing to reside in the community where the issues are occurring and you mentioned power transfer. Can you just give us some examples of where the system doesn't support these kind of things? Like how is the current system not empower people, and how does it strip people of decision making about their own food systems?   Yes! I didn't actually plan to share this one, but I will. A lot of people refer to your geographic location, and I know in my bio you mentioned this, but your zip code shouldn't determine your life expectancy. And right now that does. We don't have the autonomy to create the environment around us. It's so saturated with capitalism and other things that don't put people first. So I think food apartheid instead of the food desert reference is a real way that people are disenfranchised and not in power. And that's also a definition from Dara Cooper, that it's the systemic destruction of Black self-determination to control our food. This includes land, resource stuff, and discrimination, hypersaturation of destructive foods and predatory marketing in a blatantly discriminatory, corporate-controlled food system that results in our communities suffering from some of the highest rates of heart disease and diabetes of all time. Many, like I said, use the term food desert, but food apartheid is a much more accurate representation of the structural, racialized inequities that are perpetuated through our current system.   Okay, thanks. There's a lot in there that needs to kind of get disentangled. So let's talk about some possible advances in solutions. And I know in this context, food co-ops come up a lot. In your mind, how do food co-ops become a tool for not just providing healthy food for communities but also to make movement on racial and economic justice?   Yes, I think co-ops are about collective power. They're not just a non-extractive way to exchange goods and services, but they're about the collective buying power, the collective political power, and especially the collective people power. It's a way that you can actually, in person, in real life, practice democratic governance. And you can create shared principles and values and shared wealth and authority and it's not concentrated in just the hands of a few, or just the people who are making decisions. And it's not just an economic sense. I really listen to all our members who are in the process of building of even a retail store, grocery, co-op, and it's about a political space. It's more than just groceries. So they're a pillar of our community. And then especially in the Black community, co-ops have always been built out of necessity. I love Dr. Monica White's "Freedom Farmers" book, when she describes Fannie Lou Hamer, when it describes food as a political weapon. We know we can control our food systems and the means of production when we create these places of distribution, and we can use them as a tool to build towards freedom. So I'm excited to be doing that work with the Alliance.   Well, it's exciting to me. And when you talk about food co-ops being more than groceries, let's explore that a little bit more if you wouldn't mind. So if you walked into a food co-op, you'd get a picture of things, groceries, but you're building a picture here that talks a lot more than just those things. So there's community empowerment, there's community engagement, there's wealth creation in the community. But I'm saying these things and you're the one who really knows them. So tell us a little bit more about what's there besides the groceries.   Yeah, there is absolutely community. There's spaces for people to learn together about healthy products. There can be a cooking class attached. When I think about these things, I'm speaking about specific co-ops. One in Dayton, Ohio, Gem City, they have a doula co-op and a health room where maternal health access can be made available. There's also just the vibe. There's the music that you hear. There's the people that you see. It's like not only providing jobs, but it's providing living wage jobs that are able to provide upper mobilization. So it's, like I said, more than groceries. It's a vibe. It's community. It's all the things that you could imagine, but sometimes people outside of the community aren't able to imagine that. Like investors and things. If there isn't a grocery store there for the past 50 years, why would someone bring one there now? But when the community knows that this is something that they need and they're putting their all into it, they'll build it for 10 to 12 years before they even see a store. So I'm excited to actually go into one of the co-ops in Detroit and they're groundbreaking this weekend, so I know that they'll be building it really soon and I can open the doors and be their guest.   So my background is being a researcher and the researcher ordinarily looks at a situation like this and says what kind of outcomes can be measured? And one thing that the researchers might automatically think about would be what are the health outcomes in the community from having healthier diets? But you're talking about a lot more than that, even intangible things like morale of the community, the engagement, the happiness, and then of course there's the economic development. So it sounds like there's an awful lot involved in these efforts, isn't there?   Absolutely. And organizing them, you never know what you'll get when you bring the community together. And beautiful things are born especially when they have control. And it's about participatory budgeting as well and everyone being clear where the funds are going, and it feels good to be a part of something that you can see the effort, the fruits of your labor.   So I'm assuming that your theory on this is that if the solutions for these very significant food problems come from within the community itself, you're going to get more buy-in, better morale, and ultimately better solutions. Is that correct?   Absolutely, right on.   Let me ask a final question about farmers, because they're obviously a really important part of this. Could you talk about the institutional and systemic harm that Black farmers and landowners have experienced and how your Alliance is going about addressing this?   I'm sure a lot of people have heard the statistic about the land that Black farmers no longer have control over. We think back into the 1920s when there were nearly 1 million Black farmers in the United States, and now we're less than 1% of farmers, but more so the land that has been taken away. It's said to be between more than 15 to 19 million acres. And I say land that's been taken away because land has never been lost. You can lose your keys. You can't lose land. It's been Black communities, systemically disenfranchised, and has been this way for decades. And it's interesting to see it continue to play out even today with the debt relief for Black farmers, lawsuits that are still going on. The Alliance is supporting that. But more importantly, we're building an alternative. We're looking to remove land from the speculative market. We have a goal of 15 million acres to do such where it will be in perpetually hands of Black land stewards to continue to build for Black food sovereignty. So that's our resource commons, and that is actually democratically governed by seven of our members on our Resource Commons Council. We're looking to have our first piece of land this year and to continue building and purchasing and removing the land from the speculative market. We are also hosting land stewardship trainings throughout the United States with our members and resourcing them to ensure that we're not only having land to steward, but also having stewards.     Bio:   Dr. Jas is an applied food systems research and policy-based specialist. She partners with academic research teams, anchor institutions, philanthropic foundations, and community-based organizations to identify root causes of and develop innovative solutions to food system challenges. Dr. Jas received her master's degree in Community Planning from Auburn University and Ph.D. in Integrative Public Policy and Development from Tuskegee University. As a New Orleans native and farmer, she has developed a unique perspective when it comes to food and the effects that it has on communities. Dr. Jas believes that your zip code should not determine your life expectancy, and building relationships are essential to creating a sustainable and just food system. Twitter - https://twitter.com/nbfja https://twitter.com/drjas9 Instagram - https://www.instagram.com/blackfoodjustice/ https://www.instagram.com/dr.jas2020/ Facebook - https://www.facebook.com/blackfoodjustice/ Website - https://www.blackfoodjustice.org/

Today, we're talking with the President of North Carolina Farm Bureau, Shawn Harding. Farm Bureau is the state's largest farming organization is often referred to as the voice of North Carolina agriculture. In this interview, we'll explore the diverse ways this vital association supports North Carolina farmers and growers. I might also say that there are Farm Bureaus in all 50 states, and from what I understand, North, it's a special pleasure to have Shawn with us. Interview Summary   I was mentioning before we went live that our center has had a nice relationship with Farm Bureau over a number of years. And one thing that was especially, meaningful to us is with your predecessor, Larry Wooten, and several of his colleagues took us on a tour of farms in Eastern North Carolina. And that was very eye opening and a very moving experience for us to get to talk to farmers and understand a little better. So, I appreciated the work of Farm Bureau before, but especially, after that. So, let's begin. You became President of the North Carolina Farm Bureau nearly two years ago. And anyone in the agriculture world knows a Farm Bureau but others may know less. Would you mind telling us what Farm Bureau does?   Yes, certainly. As you mentioned earlier on, we often refer ourselves as the voice of agriculture because that's what we do. We spread the message of farmers and agriculture. And, you know, what's interesting is our organization started 1936 by farmers who felt like they needed a voice. And in 1936 there were a lot of people on the farm. Now, very few people on the farm, very few people that really understand agriculture. So, we feel like our mission to be that voice for agriculture is more relevant now today than ever before. And we try to stay core to that mission and just spreading the word of our farmers and agriculture and what they do.   I thought I heard that North Carolina Farm Bureau was the second largest in the country. I don't know if that was correct then or still is, but what explains why North Carolina has such a robust Farm Bureau presence?   Well, in 1936 a group of farmers got together and started this organization and really their mission was just to help farmers but also help rural people to any kind of issues they had. And in 1953, believe it or not way back then they were having trouble getting insurance. And so, we started an insurance company. In order to buy insurance from North Carolina Farm Bureau you had to be a member. And so, you joined and you were able to participate in our insurance company. And it was very successful very helpful for our rural families back then. And thankfully, we've been very successful over the years proud of our insurance company. And that's one of the reasons that we have such a large membership in North Carolina. We just crossed 600,000 members for the first time in our state, which does make us the second largest Farm Bureau in the nation. And so, certainly we have many members who have no connection to agriculture but just enjoy and appreciate our insurance company. So, we're proud of that but anyone can join North Carolina Farm Bureau. $25 membership. And if you want to support farmers and support our mission certainly anyone can join. Tennessee Farm Bureau is the largest Farm Bureau, our neighbors to the west. And so, we're looking at how long before we could be number one, but we'll see how that goes.   Well, good luck. And 600,000 is pretty impressive, I must say. So, I'd like to talk about one particular part of the work that you and your colleagues are doing, your Young Farmer program. And I recall hearing from Bert Pitt in Edgecombe County saying that the average age of farmers in North Carolina is around 67. And farming is so critical to the future. I'd like to hear about the kinds of support and recognition that your Young Farmer program offers to newer generations of farmers.   Thank you for asking about that program. It's really near and dear to our hearts. I'm a product of the Young Farmer program. Actually, Larry Wooten was a product of the Young Farmer program. And so, we use it as a leadership development program in our organization, but it's more than just leadership development. Farming can be a very isolated occupation and sometimes you can feel like you're just out there on your own and don't have any support. So, one of the great things, I think, our Young Farmer program does, it brings young people together. As you said, there's not a lot of them in agriculture. And so, it brings them together and they really get to support each other to see, hey, we've got some of the same issues. We're dealing with some of the same things. And so, it's a real support system for our young people in agriculture. And as you mentioned, I mean, that's vital with the age of farmers now, but I'm excited, I'm excited about the future. I see young people getting involved in agriculture that are first-generation farmers. So, I think, I often say when I was coming along, it maybe wasn't cool to be in agriculture, but now it's a very cool and hip thing to be involved in agriculture. And that's exciting to me to see young people coming in that haven't had a history in it.   It's nice to hear that optimistic note in your voice. And boy, that would be great if young people really do come in with a kind of enthusiasm that you're seeing in them. So, that's great. You mentioned your own experience in farming. Could you tell us a little bit more about that? What kind of a farm did you grow up on and what kind of farming did you do yourself?   Sure, absolutely. I grew up in Eastern North Carolina, in Beaufort County. A little town called Chocowinity and my grandfather was farming and my father actually, came into farming in the seventies. And so, we grew up on a farm, typical Eastern North Carolina farm that was a tobacco and grain operation. That's kind of what most everybody did a little bit of. And we were small farmers and just enjoy that life. Went to NC State after high school and studied agriculture. And unfortunately, I lost my father the last year of college. And so, you were talking about the age of farmers and certainly, it's difficult to get started in agriculture as a young person, but I had that opportunity right out of college. And so, started farming early, again, going back to tobacco and grain and doing those kind of things. And working with my brother on the farm. We had a partnership, things were going well. And then we came into the nineties and challenges in the tobacco industry. We had the tobacco buyout that came along in 2004. About that time, my wife had started a little side operation with strawberries and I just I looked at it as an opportunity to change what we were doing on the farm. I saw how many people loved coming to the farm to pick strawberries and learn about what we did in agriculture. And I just thought, I think this is the future. So we stopped growing tobacco. We became a strawberry farm. And then of course, added to the strawberries with blueberries, blackberries, all kinds of fruits and vegetables, and just went direct to the consumer. And thankfully, we were very blessed to be successful in that. The opportunity to be Farm Bureau President obviously, came along and and I thought it was a great opportunity for me but also for my children. I have two boys and back on the farm now that are running the farm. Again, giving them an opportunity to start at a younger age in agriculture, and also giving me an opportunity to do something that I love. And that's lead this organization and talk about farming. So, that's a little bit of my story and how I got to where I am and just love agriculture and love what I'm doing.   At the time we're recording this, we're about to enter the full swing of the strawberry season. So, I was really excited to hear you talk about strawberries. More than that, it's interesting to hear about the transition of your farm and the historical things that shape that. So, let's get back to Farm Bureau. And I know that Farm Bureau does a lot to bring agriculture concerns to policy makers, both at the state level in North Carolina and the national level. And that helps farmers prepare to make the case for North Carolina agriculture. Could you talk about the advocacy programming that you do?   It's really one of the top line things that we're involved in. I mentioned that we're the voice of agriculture and that can mean a lot of different things. As I said, we want to share with the public about what farmers do. And part of that public is our legislators who many have been separated from the farm for several generations and don't really understand modern agriculture. So, quite a task there. And so, we stay involved in that. I'm very proud of our advocacy efforts. The other part I would say on that is certainly we have a lobbying team here at Farm Bureau but what we do, what is special about Farm Bureau is we use the term grassroots operation you mentioned we're in every county in North Carolina. And we encourage our volunteer farmers to advocate for what they do. What we found is when you walk in an office as a lobbyist and then they expect you to be at a certain place, but when you take an actual farmer to a legislator, to a Congressman, to a Senator, they appreciate that. And so, we really challenge our young farmers, our women, all our farmers, all our volunteers, to be involved in advocacy for what they do. And that's what I'm proud of as an organization. Our policies come from our people. So, I sit in this role as President, but I don't set the policy for the Farm Bureau. Our people set the policy. And so, we have a policy development process that we go through every year and they really tell us what's important to them. So, I think it's a really fascinating process that was drawn up many years ago and it works really well.   I can see how farmers would be such important advocacy voices. When we were doing the tour of farms that I mentioned before, we found the farmers to be talented, passionate but also very humble people. So, you can see how they would have a special role in this. It was interesting to hear you talk about that. I'd like to ask you also about regenerative agriculture. We've done a number of podcasts with farmers and others from around the country involved in regenerative agriculture. And they've talked about techniques such as diverse, no-till, rob crow techniques, mob grazing for livestock and other things to improve the environment and produce food at the same time even though to improve the nutrient profile in food and to help be more resilient in the face of changing weather conditions. So, how do you think North Carolina itself is poised to deal with regenerative agriculture and those advances?   I'm, of course, very biased. I believe we have some of the best farmers, in the country, in the world, at North Carolina that are resilient, adaptive and always looking for the right thing to do. And so, when talk about climate change and how agriculture can be a part of that then I think we're at the forefront of it. Many people think about this issue and we all have opinions and things we feel like we ought to do and need to do. And that's great, but I don't think people really think about nobody deals with the climate more than farmers. We deal with the storms, we deal with cold, the heat, everything that comes along with it. So, we're on the front lines of this and certainly, we're ready to look at practices that will help the climate change issue. And I think, farmers are always ready to do that, that with a caveat also, always of saying we have to stay in business. We have to have practices that will keep us on the farm so that we can do the positive things we need to do. But we certainly feel like there's a lot of great research going on right now to say, here's some things that we can do to help reverse this climate change issue and agriculture can play a big role in that. And so, I think our farmers stand ready to be on the front lines of that issue.   That sounds really impressive because you're talking about the influence of climate on the agriculture world and then in turn the influence of agriculture on climate and that relationship arrow going in both directions is such an important part of the overall picture that we're facing in the future. So, it's nice to know that North Carolina farmers, in particular, are focusing on that. And speaking of that, the farm bill is such an important piece of legislation nationally, and obviously, for North Carolina farmers as well. I'd love to hear your thoughts on what North Carolina needs from this important piece of legislation.   Well, certainly when you think about the farm bill that's coming up, we will be engaged in that heavily. Have staff members here that are already working on it now to try to say, you know, what's our priority. I think if we want to talk about priorities in the farm bill and for the last couple of farm bills, I think this has sort of been the direction our country has gone is crop insurance. We've just said, agriculture's such a volatile business to be in with climate again as we talked about and storms that the safety net that needs to be there for our farmers with crop insurance is a really important piece for us. And so, we'll continue to talk about that as we head into this farm bill negotiation, the next bill, because that really is what helps keep our farmers on the farm when these devastating weather events happen. And we certainly feel like that's important for our country. We've all seen what's happened the last few years with just turmoil around the world. And so, we say food policy is good security policy, and so, we need to have a good food security policy. And that starts with keeping our farmers on the farm and being successful. And that obviously, crop insurance is the biggest part of that farm bill that we'll be looking at.   I'm happy you mentioned the vulnerability that farmers face because I think most people who don't dive deeply into agriculture don't realize the number of vulnerabilities that farmers have. There are the weather vulnerabilities we talked about today. There are unexpected market fluctuations. There are complicated relationships with the companies that buy their products. All kinds of things go on in that world that make it a very precarious position that farmers are in. And it's amazing that they're able to tolerate that and still prevail generation after generation. So, it says a lot about the kind of mindset and personalities of farmers doesn't it?   We often talk about it's a love, it is a passion. You mentioned seeing that with some of our farmers and it has to be. I mean, just this year, we've seen prices for inputs rise by three times. And certainly, prices of commodities have risen. And some people are saying, well, that equals out. But what I'm trying to tell the general public is we just tripled the risk that we're putting in the ground. With the seed this spring. We just tripled the risk, the seed, the cost of fertilizer. And we don't know what we'll get out of it. So, that's what agriculture is. You mentioned that it's a lot of volatility, but we do it, we love it. I think most farmers feel like it's their responsibility to help feed the world. And so, we want to continue to do that. So, we appreciate the partnerships and people understanding what we do, but there's a lot of risk in it. Absolutely.   I was impressed on the farm tour we were doing with some of the things that you just mentioned. One, was how passionate the farmers were about their work and how much they felt they were performing a very important service for the world, but also how many generations of a family there tended to be on farms and how the farmers felt that they wanted to turn the farm over to children in better shape than they had inherited it themselves. It was very interesting way of thinking. So, that passion I must really impress you all the time, too.   Absolutely, and as I mentioned my story, I'm sort of living it. I go home now every other weekend, see my boys and the pride they have in growing our things and selling it to local consumers. And there is a pride that goes along with that just to see that, to see your, leaving the next generation in a better place. And that's what our farms and farmers are trying to do to just leave it better than we found it. And that goes with our families. But it also goes with our land. You know, the water the air, the soil, that's how we make our living. So, we're trying to leave it better than we found it.   Bio Shawn Harding was elected president of the North Carolina Farm Bureau in December 2019. Harding grew up and farmed in Beaufort County. He previously served the Farm Bureau in various roles, including president in Beaufort County, member of the state board of directors and state public policy director. He is a graduate of the Agricultural Institute, part of NC State University's College of Agriculture and Life Sciences.

Today, we're talking to a change management leader, a person who is advancing social justice through food co-ops. Darnell Adams co-leads Firebrand Cooperative, a new consultancy helping nonprofits, cooperatives, and other socially responsible organizations throughout the US. In a recent article, she wrote for "Nonprofit Quarterly" that a food co-op isn't a luxury item, but the lifeblood of their communities. Interview Summary   So let's jump right in. You've written that a new wave of leaders is organizing in communities, Black communities, Latinx, Indigenous, rural, immigrant communities, and communities lacking in wealth overall. How have your experiences led your work in supporting economic development through food?   Yeah, it's such an interesting journey I've been on. So I'm going to step back just a minute to say how I landed in the places that I've started to work. Certainly my interest in food is shaped by my experience in the world and my childhood experiences. My mother, who is an immigrant, my father, who's an immigrant - their relation to food and the African diaspora. I grew up understanding what food meant in terms of identity, in terms of nutrition, etc. So I had my own thoughts about food certainly from those experiences, and also had my own business as a caterer for many years. I had that understanding of what it means to be a small business, and launching a business and all of the trials and tribulations of doing that. And in the process of running that business I came to find a location where I could situate that business in a way that was affordable to me using a shared kitchen space that was located in Boston, Massachusetts. Then I really started to develop a broader understanding of some of the economic considerations, not just mine, but many of the producers were having in terms of how to run a viable business, and what supports were needed or missing in their experiences. It's kind of a long story and I won't get into it how it happened, but it so happened that at a certain point, I began a new career as managing director of that shared space kitchen. That was a whole leap in terms of thinking about not just my small catering business, but supporting many businesses, whether they be food trucks, caterers, producers of something that was a shelf staple product or something like that. Many of those business owners were immigrants, many were women or otherwise not having the amount of capital to be able to just open up their own spaces.   Tell us a little bit more, if you would, about the kitchen itself and what kind of work it did?   Oh, sure. So the kitchen, and there are now several across the country, but at that time, there were very few of them. It was a shared space that was initially run by a CDFI - a community development funding institution - who was able to obtain funding to open up a kitchen space knowing that there were many people who wanted to run food businesses, or start a food business, but were unable to because of the cost of actually renting out a space. They needed space to use and that would be inspected by inspectional services and given the green light to work and sell their products. So the kitchen did actually aid some caterers and other people who were working underground in their own houses, not being certified, etc., and therefore not able to expand their business. The idea of shared kitchens is really, really important. Certainly it was the way that I was able to launch my business and able to run it for some years because it was affordable to me. And at that one location was able to grow the business and actually move the location to a bigger space. I have a really long story there, but it's CommonWealth Kitchen in Boston and it is still thriving. They were able to actually buy the building recently, and the space that is still producing quite a lot of businesses that are thriving and also moving into their own spaces. The kitchen is able to give the support, not only just the physical space, but the technical assistance that's necessary to launch a business, to have a business thrive, and then maybe that businesses can move on to have their own spaces. This is really important in terms of thinking about the whole ecosystem of what I would say the food system needs in many communities. But also in terms of what individually someone might actually need in terms of being able to thrive in the food business.   Well, you can see how this would be so powerful as a means of helping people get launched. And a topic that we could talk about another day might be how can these things be put in more places with more support so more people, their businesses could be facilitated by it. But let me turn our attention to the issue of food sovereignty. So I know you've done a lot of thinking about food sovereignty, especially in Black communities. What sort of efforts are you seeing?   Yes, this actually leads me to cooperatives as one of the kind of efforts that I'm seeing in Black communities. And, if we kind of would follow the storyline, in some ways in my experience. The shared kitchen really did open my eyes to the power of collective resources, that no one person in that kitchen was able to afford having their own facility, but together, along with supportive fundraisers, etc., who are able to have a place that was actually thriving and meeting needs. And so upon me leaving that job, I was really kind of struck with what are other ways in which people are creatively thinking about collective capital and all the ways capital can be defined. And there was an opportunity with a food co-op in Boston, the Dorchester Food Co-op that was looking for a project manager to administer some of deliverables for a grant that they had. That was my entrance into the cooperative world, and realized that cooperative economics, an understanding of what people were doing in developing a co-op and all the things that it took, actually really very much aligned with my experience in general. And my philosophy in terms of how people have more entryways, more opportunities to actually take control and ownership of their own economic development. So it's not always groups from the outside looking at a community and then saying, well, we know how funds should be applied or how businesses should be created. Instead, particularly in a cooperative movement, it's the community themselves are saying, we understand exactly what we need in terms of goods and services. We actually will define for ourselves both what leadership looks like and what ownership looks like. So in terms of food sovereignty movement in Black communities and others as well, this incredible growth in terms of thinking - let's look at what joint ownership looks like as a different way to create sovereignty and to keep money in a community. But also money in working in the ways that are consistent with our needs. So certainly food co-ops. Lots of work around land loss, Black land loss for farmers, and creating land trusts. Again, this idea, while not cooperative, is still looking at kind of a collective way of ownership that keeps land off the speculative market. Also just supporting the farmers that are there, both in rural areas and in urban farming. So there is kind of a whole landscape where people are really thinking very deeply and working very hard on all the aspects of food sovereignty, from growing to shopping to workers.   So can you explain some of the opportunities that get created through these kind of efforts and how these opportunities help create social justice?   Yes. This is what's so incredibly exciting and certainly keeps me motivated to work with the folks that I'm working with. The opportunities are pretty broad. And I kind of mentioned a few of these before in terms of thinking about what ownership looks like in a very different way, in which kind of the language of ownership sometimes can get overused. And if you kind of dig deeper, it's not real ownership. So for instance, in terms of food cooperatives, the business is actually owned via shares by its members. In which case, for food co-op, typically that is the community members who are buying a share of the business. Not like being an owner of a quote unquote, a member of a big box store, where you get some money back and you say, okay, well, I'm a member of this club, but you have no ownership. There's no share that is given to you. You're not a shareholder. In the case of cooperatives, certainly you are. And so really kind of rethinking about, like, well, it's not that for goods and services that are might be absent in a community that we need to wait for another entity to come and offer to us what they have, and it may or may not be a match for what we actually really need. But as owners, the folks who are actually going to benefit from the existence of the business, from the profits of the business, by the goods and services that are being delivered, that ownership really does take a whole different sort of meaning that a lot of people are accustomed to. And then there's also the opportunity for leadership also in ways that I think are certainly opportunities that many people may not have had before, and I can certainly speak from my experience that as the project manager of the cooperative, that stepping into that role required leadership and vision in ways that I had not encountered before when I was working for another entity, and I was staff doing what I needed to do, but because it's a grassroots effort, because the systems and the processes, all of that are things that are kind of created by the entity, it meant all the ways to experience all sorts of different levels of leadership and consideration that in many cases would not be something that people would experience.   Right, so, I mean, you're painting a really wonderful picture of how many people in a community can play different roles and develop leadership abilities that are possible through these, so those are some of the opportunities. What are some of the challenges, and what do you think such groups need most?   Right - I'm certainly, you probably can tell by my description of things, very much enthusiastic about the opportunities and the vision for many of these efforts. Particularly the food cooperatives that are happening all across the country in Black communities, and the challenges are also real. So some of that is certainly capital, and I can kind of outline a bit on some of the struggles there and the ways that it can be deployed that would be helpful to some of these organizations. So in terms of capital, one thing is really on some basic level, kind of unknowing in many ways from where groups who might be able to provide capital and even understanding what a cooperative is and how it works. So it's kind of the general idea that, well, cooperatives are out there. I think maybe they sell granola and things, but beyond that, not a kind of deeper understanding of kind of inner workings of a cooperative and how their money might actually be aligned to other social justice issues that they might be funding. So it's like just the awareness and saying, okay, well, this seems to make sense in terms of, yes, if I'm thinking more about nutrition, about any number of things, but say nutrition, food access, economic development, having a better and more refined understanding of what cooperatives offer might actually kind of bridge that gap between the funders and what's needed in order to create a cooperative. Secondly is the amount of time it takes to develop a cooperative, which can be years. It definitely requires a lot of people taking a lot of time that is often voluntary, but can also kind of stretch them out of time that it takes for people to develop these co-ops in their communities because they're trying to fit it in amongst all the other things that they're trying to do in their lives. They're not paid for it necessarily, so I think a certain amount of funding, even just for a paid project manager to kind of move forward what is a complicated business, to kind of shorten the length of time so the delivery of goods and services can happen in a more rapid fashion to actually address some of the issues that we're seeing in Black communities. So that is a couple things there, which is the time it kind of can take, and also lack of capital resources that some of these groups have, and then trying to certainly work around that.     Bio   Darnell Adams, of Firebrand Cooperative, is a dynamic leadership coach, facilitator and business strategist, who has over two decades of experience working with nonprofit, for profit and cooperative businesses. She has been personally recognized in "Bold Thinkers Who Are Shaping Our City'' by Boston Magazine's Power of Ideas and as a Social Innovator by the Social Innovation Forum accelerator program. She develops and facilitates strategic plans, special projects, and workshops, providing expertise and training on an array of topics including implicit bias, power and equity. Darnell has presented to government officials, university administrators, and industry leaders to create social and economic change. Darnell has a Master of Education from Harvard University and is a Certified Leadership Coach.

Today, we're exploring an agricultural innovation in the state of Qatar in Western Asia. Qatar is a wealthy, densely populated country located on the Northeast coast of the Arabian peninsula and leads the world in liquified natural gas exports. But the country's desert climate is harsh and the agriculture there is challenging. That's where shipping containers, artificial light and vertical farming techniques come into play. Our guest today is horticulturalist Mohamed Hassouna from the Qur-anic Botanic Garden in Qatar. He and his partners at the University of Arizona are developing a shipping container vertical farming model as a way to expand local food production. Interview Summary   So first let's set the stage for our listeners. Could you describe the agricultural challenges in Qatar given the country's dry climate?   Thank you for your introduction. Qatar, as other countries located in the Arabia peninsula and also in the Arabian states, are facing very harsh weather conditions. Particularly in Qatar, the weather here is hot desert weather characterized by sparse precipitations and high summer temperature experienced with high humidity, high solar radiation and poor soil additionally to strong winds. And this limits the agriculture sector to the months of October to April. Every year, this is the agriculture season here from October to April then the temperature is fine and can allow for producing vegetables. Also the land, the Arab land, suitable for agriculture is very limited. The last inventory here in the state estimated that there is only 60,000 hectares available for the agriculture sector. Also, we have a challenge with water. Water scarcity. The agriculture sector here in Qatar consumes 90% of the available water for the state. A big challenge is also that the agriculture sector consume about 36% of the available water in the aquifer. And as I told you, we have very minimum amount of rain every year. It's about 80 millimeters on average, every year. So production of agriculture in Qatar is difficult.   Well, the picture you paint is really striking and I can imagine those challenges. So what role could your Botanic garden play in addressing food security in the country, closing the food security gap for communities, and also attending to the environment?   Yes! The Qur-anic Botanic Garden is an active member in the community development sector in Qatar Foundation. It takes the issue of community awareness and education from school students to housewife to training even professionals to engage in the investment in agriculture. We established at the Qur-anic Botanic Garden an extra curriculum educational program for school students - from early stage to especially secondary schools students - to learn about the challenges of food security in Qatar, and what are the technologies they can learn. Students are leading the future here in Qatar. Without students being aware about the challenges facing the food security and the agriculture production, we cannot guarantee a future outlook of food security. Also the Qur-anic Botanic Garden has been partnered with Qatar Development Bank, and this is the official bank assigned to develop industry like also agriculture sector. So, anyone from Qatar who would like to take a loan to invest in the agriculture sector, we have the mission to train them on the latest technology of horticulture practices. They can use or they can establish greenhouses or they can establish other modern system for a production of vegetables. Either in their homes or in farms outside. Also Qur-anic Botanic Garden established a hotline for household people. There is now community farming in Qatar. People would like to plant their own vegetables in their home. The hotline is answering all their inquiries about seed selections, seedlings, how to prepare soil, how to make pesticides.   So let's talk a little more deeply now about vertical farming. Can you describe what that is?   Vertical farming involves growing crops in controlled indoor environments with precise lab nutrients and temperatures. In vertical farming, plants are stacked in a layers that may reach several storage unit stories - from personal community scale vegetables or herbal growing to vast building for commercial production of a wide range of crops. Due to the pressure for agriculture land, this makes us look to maximization for food production. Model technology like vertical farming is increasingly something we are turning to for greater crop yield.   I'm envisioning in my mind what the vertical farming could look like. And I'm thinking that in order to produce enough food say to feed a population, you need an awful lot of containers and an awful lot of technology to accompany those containers. Can that be done on a large enough scale?   Before we answer this, we need to go through the pro and cons for vertical farming. If we can speak first about advantages of vertical farming, we can say that vertical farming can ensure crop production year round in desert harsh weather regions like Qatar or other countries in the Arabian Peninsula. And also a controlled growing condition in a vertical farm allow production without chemical pesticides used when needed to deal with any problems from insects. Also, because crops in vertical farming are growing under controlled environmental conditions, they are safe from extreme weather events, such as drought, high temperature, severe winds that also we are facing here. Hydroponic growing techniques used in vertical farming use about 70% less of water than normal agriculture. So, growing the crops indoor reduces the use of tractors and other machinery that also produce a lot of CO2 and this is could be a climate friendly industry. So this is some advantage behind vertical farming that can give us strong signal to say yes, vertical farming can feed a lot of people around the world. Especially in the area that have these two main challenges, availability of vertical soil and a scarcity of water.   Oh, it's so interesting to hear you speak about this. So it sounds like you're optimistic that the technologies can continue to develop and that the vertical farming approach could really help contribute to national food security in your country. But so what do you think are the main opportunities there and what do you think the main challenges are?   Thank you for this question, Kelly. Indeed, I'm optimistic about this industry. Cost of land and building for vertical farming is not easy and it's not also available for all countries and for all people. It needs solar isolation, it needs air conditioners. It needs precise lighting. It needs operation computers. So it needs also specific types of nutrients to be introduced in the cycle of production for fertilization. Here, you bring all the inputs of production cycle. In what you add to the water or to directly to the plants. So the cost is high on the energy side also. You use high amount of energy at a time we are calling everyone to reduce the use of energy and avoid production of CO2. Also, you're aware of expansion of organic agriculture everywhere in the world. So, there are now questions about vertical farming certification. How we can certify or how we can consider merging between organic agriculture and vertical farming. As I said, we use all chemical nutrients in vertical farming to provide the plant with sufficient amount of all of other nutrients required for production. In this case, organic agriculture certification cannot be applied. And scientists in USDA and FAO and many other organization are looking to find a way they can provide a product from vertical farming certified under organic agriculture systems. Two points now, the limited number of crop species in vertical farming. Also, you cannot produce these tall plants that you can grow everywhere or creeping plants that grow everywhere in the field, in the natural field. So you are limited with this layers of a production. So mainly you produce leaves and produce and herbal plants. So we have limited number of crops. Still, also pollination. In natural, we have a bees that make pollinations for the production of vegetables, even for fruits, every, everything. But here, we doesn't have a pollination so we need to go with artificial pollination and this also extra cost to have a special type of bees that you need to put inside the glass houses or inside the building you produce in to secure pollination to complete the cycle of production.   Bio   Mohamed Hassouna is a Horticulturist at the Qur'anic Botanic Garden (QBG), a member of the Qatar Foundation for Education, Science and Community Development. He joined Qatar Foundation in late 2010. He guides and supervises agricultural laborers, coordinating work schedules and performing evaluations, and prescribes fertilizers, pesticides, herbicides and other compounds required for plant care and development. And, he contributes to QBG's continual education-based conservation programs targeting the Qatari community, especially in the fields of food security, forestation and plant propagation. He is an alumnus of the Advanced International Training Programme on Plant Breeding & Seed Production and Plant Genetic Resources at the Swedish University of Agricultural Sciences in Uppsala, Sweden – Classes of 2008 and 2013. He is finalizing a Master of Science degree in Sustainable Agriculture & Environment and in addition holds a Higher Diploma – Graduate Education – in the same field and a Bachelor of Science degree in Agriculture Sciences & Education, which he gained while studying in Egypt.

Today, we're going to talk salt with Dr. Michael Jacobson, former president and co-founder of the Center for Science in the Public Interest. Dr. Jacobson is one of the authors of an important article published recently in the journal Hypertension. The article comes to a startling conclusion that delays in implementing voluntary sodium reduction targets by the food and restaurant industry may result in nearly 265,000 preventable deaths between 2017 and 2031. Interview Summary   So Mike, you've been a hero of mine for decades and I really admire the work you've done on so many different topics. And you and I have written a thing or two over the years which has been a great pleasure for me to do, but on things like soda taxes and nutrition policy, but you've also had a really long standing deep interest in the issue of salt. So let's start with the following question. Tell us why salt is a problem.   The main concern about too much salt is that it contributes to high blood pressure. That's a major cause of heart attacks and strokes, kidney disease, and probably some other problems both here in the United States and throughout the world. In almost all cultures, people are drinking/eating excessive amounts of salt far more than what the World Health Organization or the Department of Health and Human Services here in the United States recommends. Hypertension experts have been concerned about excess salt for decades and decades. Back in 1969, there was a White House conference on food, nutrition, and health and one of the recommendations was to reduce sodium intake. Mostly sodium chloride, but also some other ingredients in food besides salt and nothing was done. I first got involved in this in 1977 when a newly minted nutritionist came to Center for Science in the Public Interest, Bonnie Leaman. And I asked her to look into salt and what she found was very disconcerting. It seemed like a wide range of hypertension experts was encouraging people to consume less salt and some people were urgent government action. So in 1978, the Center for Science in the Public Interest petitioned the Food and Drug Administration to restrict levels of sodium and packaged in restaurant foods and require warnings on foods that contained excessive amounts of sodium. Almost nothing was done and the next 45 years or so is just a history of inaction by the most responsible health officials in the country. And similar inaction was occurring worldwide. And there've been Institute of Medicine reports, World Health Organization reports and a whole bunch of things like that. But Americans are consuming today just about the same amount of sodium as we were consuming 10, 20, 30 or more years ago. It's really a sad tale about government in action and we can talk about some of the reasons why that's happened.   I'd love to hear some of that and boy, it's pretty disheartening that the scientific evidence has been around so lot, but so is the inaction. So I'd like to get to the why of this in a minute, but let me ask you a question first. Does the problem mainly come from how you and I, and everyone else, uses a salt shaker on foods at home or in restaurants, or is it salt added by the industry to foods that people buy?   Well 100 years ago, it probably would've been the salt shaker, but now the vast majority of foods that we eat come in boxes and cans. They come in freezer cases at grocery stores and restaurants. We get about a third of our food from restaurants and that's really the culprit - and it should make it easier to solve this problem. But instead of having to persuade 330 million people to put down the salt shaker, the government could set limits on the amount of sodium in different packaged foods. Or it could require warning notices on foods to contain excessive amounts of sodium and let me just give you a few examples. This is from my book, Salt Wars, of some restaurant meals and to give you just a benchmark. The government recommends that people consume no more than 2300 milligrams of sodium per day, 2300 milligrams. It's about a teaspoon worth of salt. So compared to the 2300 milligrams, if you get a spicy chicken sandwich with fries and chicken soup at Chick-fil-A, you're getting 50% more than that. You're getting 3,800 milligrams of sodium. A roasted turkey breast sandwich at Jason's Deli, 4,200. At Chili's restaurant, honey chipotle crispers and waffles, 4,700, twice as much as the recommendation. At an AMC movie theater, you can get a soft pretzel with more than three times as much sodium. So the amounts are just outrageous and that reflects that it's cheap and easy to add salt to a food and most people like the taste of salt, it's built into us genetically and the portions at restaurants are gargantuan. So that's turned restaurant food into a major problem for sodium.   Mike, I think you've started to answer the question about why these changes haven't been made. It sounds like industry is probably having pretty powerful sway over the lack of action that legislators have had in the past on this issue. Is that true? Are they just thinking we don't want to make this change because people will like our products more if they're high in sodium?   Yes, and they're afraid that if their company lowers sodium, a competitor might not lower sodium. And that's actually an advantage of having mandatory limits but the issue is the same as getting lead out of gasoline, getting DDT off of farms. Anytime there's a big corporate interest, big financial interest in the status quo, those companies, those industries don't want to change. It can be expensive to change - maybe you need new machinery, a new processes. In the case of salt, though, you hardly need to do anything. Obviously, if a company wants to lower sodium, it needs to taste the food before it sends it out on the marketplace. And it might have to replace some of the salt with other seasonings, add or more vegetables or more chicken, depending on the food. But it's not rocket science at all. It should be something that companies can do and some companies have really made an effort. Remember, nobody's saying get rid of all the salt. The government recommends that we reduce sodium intake from about 3,400 milligrams a day down to about 2,300. So that's a one third reduction in intake. And some companies are meeting the FDA's recommended limits right now, other companies are not. But it's something that companies just need to say “we're going to do it.” And usually they can change the food so that there's no difference in taste whatsoever. And there's one little trick that more and more companies are using is to replace table salt with potassium salt. Replace sodium chloride with potassium chloride, which isn't quite as salty as sodium chloride, regular salt. It's a great replacement and you can replace maybe a third of the sodium in a packaged food simply by using potassium chloride, and that extra potassium is really beneficial in reducing blood pressure and the risk of cardiovascular disease, especially for people who already have high blood pressure.   So Mike, help me understand something. If it's pretty easy to make these changes for the industry and you say that you can do it in ways that don't make taste of the foods deteriorate, why in the heck aren't the companies doing it? You think for no other reason to stay out of the way to litigation might be a good reason to do this, but certainly they could score some public health points by doing this. Why aren't they doing it?   They certainly could. It takes an effort. They have to assign people. At a big company like ConAgra or General Mills that makes hundreds of products, that means they have to do it methodically. It's going to take some time and time is money. So maybe they have to hire some extra food technologists, extra dieticians, extra chefs to figure out the right combinations. So there is some expense, it's not totally free. I talked to ConAgra many years ago about trans fat and they said, when they got rid of trans fat from their foods, partially hydrogenated oil, they also looked at sodium. They found out that in some of their foods, they were using far too much salt and the extra salt wasn't even detectable. It wasn't making foods saltier. It was just a waste. And so they were able to cut back on sodium in some of their products like Chef Boyardee. No effect on taste and they saved a little bit of money to boot. And I mentioned potassium salt. Campbell has been using potassium salt in tomato soup. Their regular red label, condensed tomato soup probably their number one seller over the decades, and they didn't tell anybody. Nobody noticed, they just reduced sodium by I think it was about a third. So the government has known this. Everybody's known that companies could lower sodium, but the government, I think, was afraid to act because of members of Congress who are so anti-regulatory. And then food and restaurant companies in their districts might lobby them to stop the government from interfering with their businesses and that's all happened. They put pressure on legislators. It happened in the 1980s, it happened in the 2010s very recently. I can't emphasize this enough. Excess sodium is causing as many as 100,000 premature deaths every year. That's an unbelievable number, year after year after year, but it's silent. Obituaries don't say he died from eating too much salt, people just accept it and that a heart attack might occur one year or 10 years earlier than it might otherwise have done, but it's just happening in the background so silently.   So Mike let's loop back to your paper and hypertension and also your book, Salt Wars. I'm happy you mentioned that and I'll mention it again at the end. So it sounds like there's a clear case for action and that the government has done something on this. The FDA has proposed some voluntary targets. Could you talk to us about that and what's kind of the history of the FDA and what the heck's taken so long?   First, the major health authorities around the world have said for decades people are eating too much sodium. You've got to cut back, especially in packaged foods. So that's the World Health Organization, American Heart Association and others, but that's indisputable and you're right. The government has done something. We have nutrition labels now so people can compare one food to another. And I urge listeners go to the grocery store, look at salad dressings or soups or breakfast cereals or packaged meats. Almost every category of food will show a range of sodium levels. And in most categories, you can lower sodium by 25% or more simply by switching from one good tasting brand to another. So we got nutrition labels but that hasn't had an overall effect on sodium consumption and probably hasn't had much effect on industry. So in 2010, the National Academy of Sciences issued a report saying that past efforts to lower sodium intake have been a failure. And now it was time for the Food and Drug Administration to set mandatory limits on sodium in packaged foods in 2010. The Food and Drug Administration immediately said it wasn't going to do mandatory limits, but would come out with some voluntary targets. It took six years for the FDA to come out with voluntary targets in 2016. That was near the end of the Obama Administration and the administration wasn't able to finalize the proposed targets. So we go into the Trump years and that's when Congress stepped in and they told the FDA that it could not move forward with some of the targets that it was proposing or it would lose its funding. So that had an effect, but surprisingly, although the Trump Administration was vehemently anti-regulatory, but the commissioner of the Food and Drug Administration, Scott Gottlieb, was in touch with reality. He was probably the only regulator in the government who was, and in 2018, he said the single most important thing to improve nutrition is to lower sodium levels and that the FDA was going to finalize those voluntary targets in 2019. Well, a few months later, Commissioner Gottlieb quit and the FDA under Trump didn't do anything. It took the Biden Administration not quite a year in October 2021 to finalize those voluntary targets. And so now we have to see will they work? And I'm skeptical that even these modest targets, which give industry two and a half years to lower sodium by an average of about 12%, I'm skeptical that they're going to have much of an impact. I don't see any real effort by the Food and Drug Administration to educate the public or to pound on industry's door and say, you got to lower sodium. I don't know if they're meeting with the big food companies and trade associations, but at least there's some movement and we should be grateful. But that over four year delay in finalizing the proposed voluntary targets has been deadly and that's what our paper calculates how many unnecessary deaths will have been caused by that four and a third year delay in finalizing those targets. And as you said earlier, it's roughly a quarter of a million unnecessary deaths between 2017 and 2031.   It's so discouraging to hear that. Now we face another period of some years that will be necessary to prove that the voluntary guidelines won't be met by the industry and then there will be a long process of talking about whether government should do anything, that'll depend of course, on who's in the White House. So, oh boy, it doesn't sound like anything's going to happen soon.   Not going to happen soon. So the FDA set targets for April 2024. It won't get the data on the effectiveness of the targets until probably 2025, 2026. And then what's it going to do if industry didn't do much? Then surely that would set the stage for mandatory limits, but to get those mandatory regulations will take many more years, probably five more years. And it's distressing how long it takes government to act on anything that touches somebody's interests, landowners, banks, food manufacturers. I've urged the Food and Drug Administration to immediately start developing mandatory limits and or warning notices for food packages so that if the targets are not met in 2024 or 2025, the FDA could immediately propose these stricter regulations and hopefully get them adopted within a couple of years, but to wait three years or four years before building that hammer to require action is naive.   So let me ask you this. So often the case that public health innovation does not begin in the United States and other countries are way out ahead of us on some of these things, is that true in the case of sodium and are there examples from other countries of things that have been done?   Well, the Britains consume about as much sodium as we do, but back in 2005 or so, the British government said people are consuming too much salt. And so it came up with voluntary targets that served as a model for the Food and Drug Administration 10 years later. And so the British government published these voluntary targets and it simultaneously mounted a major public health campaign, urging the public to read labels and reduce their sodium intakes to choose the lower sodium brands. And it also called out major companies that were lowering sodium and major companies that were not lowering sodium. So it really created an issue. And then it more quietly met with the big companies and tried to persuade them to lower sodium. And when the government looked five years later or so, it discovered that there'd been a 10 or 15% reduction in sodium intake. And remember, we don't have to stop consuming sodium, we need to make a about a one third reduction in sodium. And so that the British government got people down about one third of the way that they wanted to go. But then the government changed hands, there's been a conservative government in there and the campaign has just fallen by the wayside, but you could look at other countries. Turkey of all countries has set limits on sodium in bread, one of the major sources of sodium. South Africa has set limits on sodium, mandatory limits in bread, breakfast cereals, potato chips, cured meats, and a bunch of other categories. Israel and Chile have taken a different route. In Mexico, they require warning notices on foods that are high in sodium. So you can go around the world and at least 30 countries, maybe more have adopted either voluntary or mandatory programs to reduce sodium intake and that's partly because of the World Health Organization taking a very strong stand on this and other countries are looking at a place like Britain. Finland has achieved very significant reductions in sodium. So the examples from around the world show that it's feasible to make these really modest reductions in sodium levels and in packaged foods and people are perfectly content. I don't know if any consumer outrage about lowering sodium because people don't know the difference. It tastes just the same.   It's nice to hear some optimism in your voice when you talk about what's happened in other countries and let's hope that they will form models for the US to follow when the political will finally comes. So right now, what can consumers do? Is there anything?   Yes. The easiest thing is when you're shopping, look for lower sodium brands of just about any category of food. Jesus, there's a huge difference between Swiss cheese that's rated really low in sodium and Muenster and mozzarella and other cheeses, cheddar cheese. So just read labels carefully and you could make major reductions. At restaurants though, it's really tough because just about every meal is loaded with sodium. So the main trick I think is to use less condiments, less salad dressing, don't eat salt, avoid soup, which is just a salt bomb and then bring half of your meal home. Split the high sodium meal at least over two days, rather than eating it all at once. And then at home just when you're cooking, use less salt, use light salt where the sodium content is about half the usual and Martin and other companies make light salt. So it's within somebody's control, but it takes so much effort to compare all these labels when you're going to the store to always be adjusting the recipes that we use from cookbooks. So it'd be so much easier, so much more helpful if the food industry said, okay, we're going to really take this on, make a major public health contribution to the country.   Bio   Michael Jacobson holds a Ph.D. in microbiology from MIT and has dedicated his life to advocating sound nutrition and food safety policies. He co-founded the Center for Science in the Public Interest, was its long-time executive director, and now serves as Senior Scientist. He has written numerous books and reports. He's been honored with such awards as the Centers for Disease Control and Prevention's Hero Award (2010), the American Public Health Association's David P. Rall award for advocacy in public health (2011), and the Food Marketing Institute's Esther Peterson Consumer Service Award (1992).  

So what percentage of the world's children do you believe suffer from physical or mental stunting due to nutrition and food shortages? How lasting do you think these effects are and what can be done? Today's guest is Sharman Russell, author of the new book, Within Our Grasp: Childhood Malnutrition Worldwide and the Revolution Taking Place to End It. Among the reviews for the book, The Sunday Times of London said "Every page holds a revelation." Interview Summary   So Sharman, let me begin with sort of a fundamental question. So we led with that issue about how many of the world's children face these hunger malnutrition stunting issues. And you note it in your book that almost one in four children in the world suffers from physical mental stunting in response to malnutrition and hunger, especially in the early years of life. One thing that's noteworthy about your book is that you emphasize successful approaches or solutions to ending this kind of childhood nutrition. A lot of people make note of the problem, but finding solutions is a whole different thing all together. But with this issue being so longstanding and complex why do you think there's reason to be hopeful?   You know, I have been writing about hunger and malnutrition for the last 20 years, and I would never have been drawn to this subject, to this story, if it wasn't a hopeful one. I also happen to think that hope is the best strategy if you want to achieve something. Hope generates action, and hopelessness does not. For me, this sense of hope is about the last 20 years. At the end of the 20th Century, we finally began to understand the role of vitamins and minerals in the human body and in preventing and treating childhood malnutrition. By the turn of the century researchers had developed this wonderful, precisely fortified food medicine, these convenient packets of a peanut buttery paste, that children love, that don't need refrigeration or clean water, that can be given by parents in the home. And at the same time, importantly, we realized there isn't a single approach to ending childhood hunger. Many different things have to happen. Women need to be empowered. Families need good sanitation. They need to be protected from diseases of parasites that aggravate and even cause malnutrition. So we know what to do now. And we also know that for every dollar invested in nutrition, society gets back $16. So we have the motivation. We have the resources. That's pretty hopeful!   I'm really happy to hear the optimism in your voice. But let me ask a question, a lot of hunger is driven now by climate change and, of course, by political unrest and things. So there's the knowing what to do about hunger and what people might be fed to help offset the problem. But what about these things going on outside of the nutrient part of it? Is there reason to be optimistic on those fronts?   Those are real challenges. There's no doubt. We have to remember that nearly a quarter of the world's children are stunted, damaged because of lack of nutrients. Most of them live in peaceful countries. So while war and conflict is horrible, and what we're seeing now is absolutely horrible, most children live in peaceful countries. So those are the ones that we can start ending childhood malnutrition right now. The UN Food Systems Summit, last September determined that an additional 33 billion a year for 10 years on improved food systems could end the majority of hunger not caused by war conflict. And they were talking about all hunger, not just childhood malnutrition. So that's enormously hopeful, 33 billion a year for 10 years! I sometimes use the analogy that Americans are now spending 90 billion a year on their pets and pet products. And I think we should love our pets. Of course, we should love our pets. The important thing is we have the wealth right now to do this.   Right, and you're talking about worldwide expenses. So America wouldn't have to be the only country contributing.   We wouldn't, we shouldn't be. You know, I think the pandemic really showed us how relatively easy and important it is to spend money on public health. And that's what we can do pretty easily!   So many of your books are about nature and the environment. And you say often in, Within Our Grasp, that the goals of the environmentalist and humanitarian are aligned. What do you mean by that?   You know, in the book I sometimes say, I often say we come from the earth. Literally we are made up of the periodic table. We take in food and nutrients, and we turn that into who we are. I also say that in a world of 7.9 billion people, we have become the earth. And, and that's particularly true in terms of population growth. When I was an undergraduate in the 1970s, environmentalists were very concerned about population growth, but I don't think we understood then the connection between that and poverty. Today, we know that when families believe their children are going to survive and flourish, they tend to have smaller families. When women have access to education and employment they tend to have smaller families. Ending population growth is about ending poverty. You know, in so many ways, the environmentalist and the humanitarian want the same thing. We both want clean air and clean water. We both want sustainable agriculture in the form of agroecology and agroforestry. We both can see that if wildlife is going to thrive, the people living next door to wildlife have to thrive. And of course, as you mentioned we both want and demand action to mitigate global warming. Because right now that is causing so much suffering to the very people who contribute to it the least.   You know, it's another optimistic note, isn't it that if the humanitarian and environmentalists can come together, then there's an opportunity for larger coalition strength in advocacy numbers and things like that to call for change. Have you seen any evidence of that kind of things occurring?   Oh, I do, I have. Absolutely, the programs I saw in Malawi were almost always combining the effects on the environment with empowering women with childhood malnutrition, with getting things to market. Really we do understand. And that is the most hopeful thing that this has to be holistic, that there has to be an approach to this that includes all these important factors, and that doesn't just focus on one thing.   You know, another theme of yours is that empowering women is crucial to ending childhood malnutrition. What does that look like?   You know, one example I think would be from a program I saw in Malawi in Southeastern Africa. And I want to say like so many successful programs there, this one was run by Malawians. So they wanted to end childhood malnutrition by creating more prosperity among their smallholder farmers, encouraging them to include more diverse crops and more drought tolerant crops. And that was great. But after a few years they didn't really see a decrease in childhood malnutrition because in making a household more prosperous, this was between the city or in the country, doesn't necessarily help women and children, if women don't have a say in what to do with that extra money. So the reality too, for many women around the world is that they have all the responsibility for cooking the meals, cleaning the clothes, keeping the compound clean. And that's enormous work when you don't have running water or electricity. And they have all the responsibility for the care of children and they have half the responsibility for farming and gardening. So these women are exhausted. They're sometimes too tired to eat properly if they're pregnant or to breastfeed which is so important to the health of the young child. So in this case, this program in Malawi started working at the level of the family. They had this lively form of community theater about sharing household chores and family relationships. They had public cooking classes in which the men participated. Some of this was fun, but it was also hard work. It took time, but eventually it was successful.   You know, it's a very, very positive story. And I'm happy to hear that. And given that you mentioned Malawi, in particular, how is childhood hunger in a wealthy country like America, similar or different to a place like Malawi and other places with less wealth?   Yeah, there are similarities. We have to certainly look at child hunger here in America. I'll just talk about America. Childhood malnutrition here is mainly about children under the age of five being overweight or obese. And that's a form of malnourishment and it can lead to serious adult diseases. And this is true worldwide all over the world we are seeing an increase in being overweight or obese in young children. Here in America, we have some mineral and vitamin deficiencies. The CDC estimates that 15% of American pregnant women are iron deficient. 15% of our toddlers are iron deficient. That's really important because iron deficiency is so tied to neurological development. We have children who are food insecure, who don't know when their next meal will be. I live in New Mexico. During the pandemic one in three children we're at risk of being food insecure. But in poor countries, all of this is so much more serious and life threatening. More than 40% of women and children worldwide are anemic, not just iron deficient. Children can go blind because of a lack of vitamin A. Their growth falters because of a lack of zinc. More than 7% of the world's children are wasted, too thin for their age, more than 22% stunted, physically, mentally. So this is the kind of suffering that we don't see in wealthy countries.   Thanks for that explanation. So let me end with one final question. If you were the czar of this in the United States government, what sort of actions would you take first, let's say?   Oh, wow, if I were the czar. You know, certainly I would increase aid as much as possible. I think of aid more as reparation, especially in terms of global warming. We are so much the cause of the problem, and they're bearing the brunt of it. I would turn to those countries and say how can we help you? You know, there is that idea of decolonizing aid which I believe in strongly. We have to look at them and say, what do you need from us? How can we help? What do you want us to do? You're in charge, these are your countries. How can we serve you? So we can't put conditions on them. We can't make aid serve our purpose.

Poor nutrition is the leading cause of health issues in the United States, with nearly three in four American adults being overweight or obese, and obesity in children and young people being equally concerning. Today, we're talking with Dr. Sara Bleich, the new Director of Nutrition Security and Health Equity at the Food and Nutrition Service at the US Department of Agriculture. Dr. Bleich is leading the department's overall effort to tackle food and nutrition insecurity in the United States. Interview Summary   Sara, it's always wonderful to chat with you, and doing so in different roles that you've been in. So last time we spoke, you were doing full-time work as a professor at Harvard, and now you're in this vital position at USDA. I mean, personally, I can't think of anyone more capable and qualified for this kind of work. And so I'd like to begin by asking if you could explain the purview of your work at USDA.   I'd be happy to, and thank you. It's really kind of you to say that. And I do want to just underscore that for me, it really is an honor to have the opportunity to serve in this role and to help some of these populations that I care a lot about. And I do feel like so many folks in the public health community have been so generous with their time, their expertise, and have given really valuable feedback, so just really want to say thank you to those of you who are listening. You know who you are. You've really been a wonderful sounding board.   So in terms of my transition to federal government, at the start of the Biden administration, I took a leave. I was previously at the Harvard School of Public Health, this was in January of 2021, and I spent the first year as the Senior Advisor for COVID in the Office of the Secretary. And now, in the second year of the administration, I have this new hat, which you mentioned, which is serving as the Director of Nutrition Security and Health Equity, and this is within the Food Nutrition Service. So what's really interesting for me is that both of these jobs are brand new to USDA, so it's been really fun to sort of craft them and have the opportunity to sort of start fresh and take on these new responsibilities in very important areas. Now, one thing that they both have reminded me of is just how much I love federal service. This is my second tour of duty in government, and I honestly thought, the first time around, that I wouldn't like it so much, but I have fallen in love with federal service, I really love working at USDA, it's such a fun place to work, and I think that's largely because it has such a broad and diverse mission, so it touches the lives of 330 million Americans every day. I don't know of another job where you can have that sort of impact. So for me, it's great to be back. It's great to have an opportunity to serve, and it's especially nice to be able to do it in a topic area that I have worked on in my professional life, from the academic side, for so many years.   The enormous impact that this federal work has is clear, from what you just said, and everybody knows this, and in any administration, the country really relies on the service of people like you who are willing to take on these important tasks, so I'd like to say how much I appreciate you doing that. So it's heartening to know that the USDA is making nutrition security a key priority, and it's noteworthy that the term food security has become food and nutrition security. Can you explain why this transition has occurred in terminology and how is nutrition security being operationalized?   Great question. Really glad you asked it, because we are hearing a fair amount of confusion about the concept of nutrition security itself. And then how does it differ from the longstanding efforts at USDA to address food insecurity. So let's start with, first of all, what is nutrition security? So the concept is designed, or aims, to help us better recognize the coexistence of food insecurity and diet-related diseases and disparities. So specifically, what nutrition security means is consistent access, availability, and affordability of foods and beverages that promote wellbeing and prevent disease, and in some cases, treat disease. And this is particularly true among racial/ethnic minority populations, lower-income populations, and rural and remote populations, which includes tribal communities. Now, at USDA, nutrition security builds on and complements our efforts around food security, but it's different in two distinct ways. The first is that it, it being nutrition security, recognizes that we're not all maintaining an active healthy life that's consistent with federal recommendations, and the second is that it emphasizes taking an equity lens to our efforts. So put simply, you can think of nutrition security as having consistent and equitable access to healthy, safe, and affordable food. Now, many listeners may be aware of this definition, and may realize that it directly builds on the JAMA commentary by Dr. Dari Mozaffarian, my assistant, Dr. Sheila Fleischhacker, and Chef Jose R Andres, that came out a little over a year ago. So right now, what we're spending a whole lot of time doing, and that's why it's such a privilege to be on this podcast, is really trying to clearly articulate that definition of nutrition security to a broad range of audiences to really try to get everyone on the same page about what we're doing and how it is a complement to these long-standing efforts around food insecurity.   I'd like to explore this concept just a little bit more. So if you go back to when the country really started to take hunger seriously, in the 1960s, if the term security had been used back then, it probably would've been calorie insecurity, wouldn't it? There was an effort just to get food to people, irrespective of what it was, because they just needed to get more calories in them. But that's given way to a much more sophisticated concept that, if I'm hearing you right, not only do you want to get food to people, but the kind of food that specifically promotes health.   That's exactly right. So what we know right now about burden of disease in the US is that every year, about 600,000 people die because of diet-related conditions. Those are preventable deaths. So the burden of disease looks very different than it did 40 or 50 years ago. And so at USDA, now, what we're concerned about is not just giving people calories or food that fills up their fridge, but we want to give them calories or food that is also going to promote their health and their wellbeing, and that is the critical pivot, and the point that we're at right now, with all the messaging that we're doing, with how we're positioning the programs, and how we're prioritizing action as we move forward.   Sara, when we began the podcast, we talked about the very high rates of obesity in the country, and now you're talking about food insecurity, which people used to refer to as hunger, and a lot of people would see these as the opposite ends of the same spectrum, that they're somehow different and disconnected from one another, but they're not. Would you care to comment on that?   Food insecurity and obesity are definitely related. They often coexist. So we know, for example, that both food insecurity and excess body weight, which you can think of as obesity, they tend to be aggregated among historically disadvantaged populations. So communities of color, low-income populations. And because these two conditions coexist, it's really important to think about how do we use the power of the federal nutrition assistance programs to help move people out of food insecurity and toward nutrition security. And the power of the federal nutrition safety net is that it has a number of programs which are designed to do both. So, for example, if we look at SNAP, the Supplemental Nutrition Assistance Program formally known as food stamps, it helps about 41 million Americans - in fact, more than 41 million Americans, afford food each month. There's strong evidence which suggests that it pulls people away from food insecurity, so it lifts families out of hunger. But what we also know is that with the historic reevaluation of the Thrifty Food Plan, which is the calculation that underlies the size of the SNAP benefit that increased the benefit amount by 21%. This happened back in the fall of '21. What that does is, it puts healthy food within reach for so many participants who are on SNAP. So we view this change to SNAP, this reevaluation, which is the first permanent increase in over 45 years, we view this as core to our nutrition security efforts because it allows families to actually purchase food and put those foods within reach that are going to promote their health and their wellbeing.   Thanks for that explanation. So it sounds like some of your work lies at a very interesting intersection of two important priorities of the current administration. So on one hand, you have USDA Secretary Vilsack's goal of promoting and elevating nutrition security, which you've discussed, but also the President's goal of advancing racial equity. So what things are happening at this particular intersection of USDA?   Well, first I'll say this is an exciting time to be in government because there is so much focus on core issues that matter a lot. And so a key reason why the Secretary of Agriculture, which is Secretary Vilsack, the key reason why he is so passionately focused on nutrition security is really due to the pandemic, and the President's goal of advancing racial equity. So what we all know is that COVID-19 brought health disparities and the vital need for access to healthy food right up to the forefront. There's a study, which many listeners may be familiar with, which estimated that nearly two thirds of COVID-19 hospitalizations in the United States were due to four diet-related conditions: obesity, diabetes, hypertension, and heart failure. And so for this reason, given the disproportionate impact of COVID, its impact on diet-related conditions, and we know that it really disproportionately impacted communities of color, equity is central to our work to promote and elevate nutrition security. And so just to keep us all on the same page, let me just quickly say what we mean by equity: everyone having an equal opportunity to live the healthiest life possible, no matter who they are, where they live, or how much money they make. But when we talk about equity that also dovetails with considerations around the context in which we live. This means we also have to consider structural racism, and this is how we bring in the racial equity lens. So structural racism is not just individuals having prejudices, but it's also when racism gets produced and reproduced by laws and by rules. It becomes embedded in the economy, and so therefore, confronting racism requires that we don't just change how individuals think, but we also start to transform policies. In our efforts to build awareness around nutrition security, we are also making very concerted efforts to explain how structural racism is real, it reaches back to the beginnings of US history, and it stretches across our institutions and economy. So we emphasize that structural racism harms health in ways that can be described, measured, and dismantled. And this is a really important needle to thread as we think about nutrition security, because social disadvantage is not random. It has real roots that we need to acknowledge, and then address wherever possible. So for example, we know that there are disparities in diet-related conditions that have existed for decades, and those are associated with structural limitations to retail food outlets that sell healthier foods, among a whole host of other longstanding historical inequities. And this is where the work of nutrition security comes in, where we at USDA, and hopefully, all the listeners of this podcast, can really make a difference.   So I would challenge you all to lean in and ask yourself how can you be part of the solution. And maybe that's asking a critical research question, maybe it's trying to help connect eligible individuals with the federal nutrition assistance programs, but there are so many opportunities to promote and elevate nutrition security. And the key, going back to your question, is that the President cares about this, the Secretary of Agriculture cares about this. This is a window of opportunity to really make a difference in people's lives. And so I think that we really want to lean in as much as possible and take advantage of it.   This work is really important, so following up on something you just said about ways that people can engage with this process, so what kind of things are you seeing on the horizon, and what are the best ways for people who might be listening, to engage?   So I think it's going to depend on the lane that you sit in. If you're listening to this podcast and you're a researcher, I would ask yourself, "Given the data that I've collected, given the data that I plan to collect, could I do a secondary analysis that might help me understand some of the impacts of the COVID flexibilities that have happened during the pandemic?" For example, there was a temporary increase to the SNAP benefit, and then that became a permanent increase. There have been hundreds of waivers that have been issued which have made the programs more easily accessible. So for example, with WIC, you don't have to go in in person, you can do meetings over the phone. There are all sorts of things, all sorts of program modifications that have happened, and USDA doesn't have the bandwidth to do all that evaluation. So I'd say if you're a researcher, look at how your existing data, your existing portfolio, may be able to answer other important questions.   Second, if you are industry, or if you're somehow in the private sector, ask yourself, "What could I do to lean in on this?" For example, there is a waiver that's allowed, it's called the SNAP Incentive Waiver. Retailers can apply for this and it allows them to incentivize SNAP participants to purchase things like fresh fruits and vegetables, and whole grains that are in alignment with the dietary guidelines for Americans. This has been around for a few years, and it's a really nice way that retailers could take advantage of an existing waiver to try to help promote healthy eating purchases among SNAP participants. Which, again, covers about 41 million Americans each month. There are so many different ways to think about leaning in on this particular issue. And I would say that one of the things that we have really tried hard to do over the past several months is that we at USDA are trying to really clearly define our role. How we are trying to make a difference - with the hope that it makes it obvious how others can do complementary activities, because yes - we are investing tens of billions of dollars towards this portfolio. We are very serious about it. This is a top priority. But USDA alone cannot solve the problem of diet-related diseases and disparities. It is going to take a whole-government, if not whole-country approach. And so this is where creative ideas about how to make a difference, leveraging existing resources, is where many of you who are listening can make a difference.   Thanks for that. By the way, this focus on equity and this idea that the whole country can engage to help address these issues feels very optimistic, and just like there's hope for the future of really addressing these problems in a fundamentally different way. So back to your career: you've been in both academics and in federal service, as you mentioned earlier. So what makes you passionate about nutrition security as an issue, and do you have advice for people that might be interested in federal service?   I love questions like this, largely because when I was starting off my career, it would've been so helpful to hear what motivates people. So for me, my north star is that I've always wanted to help historically underserved populations, communities of color. How do I help them achieve a better quality of life? I'm from inner-city Baltimore. I have a twin sister and an older brother. My parents still live in the same house that I was raised in, and they were public school teachers, they're now retired, and when we were young, our family received food stamps, now SNAP, we received WIC, we received school meals. So I've always been very motivated to give back to the communities that have given me so much. And I think that our current reality is that every child and every person in this country doesn't have an equal opportunity to live a healthy life. And that's not the way that it should be. So every day, I am very, very motivated to ask myself what can I do to help push us in that direction, and push us in a meaningful way. I think the challenge is always, you can push hard but you want to push hard on things that are moveable, where you can actually make a difference. Because everything is all about timing and you want to just be very strategic about where you're going to make investments or put your energy in an area. Because this is where there's an opportunity. And I would say that if we can achieve nutrition security, it is going to change people's lives. Diet-related diseases are preventable. Hundreds of thousands of people a year don't have to die from them. And that's particularly true among communities of color. I think that many of you listening probably feel the same, but these are things that need to change. As I mentioned earlier, I do think we are at a moment where there's a window of opportunity to make a difference. And I would say, more practically, if you're interested in federal service, I would strongly encourage you to just throw your hat in the ring and apply. So you can either go through the career staff route, you could go through the political route. If you go through the career staff route, the Food Nutrition Service at USDA is going to be hiring about 450 people in the not-too-distant future, and that process has started, so I would look at usajobs.gov and see what looks interesting. And I would also consider some of the political jobs, thinking about different fellowships that would allow you to insert yourself. I never expected to love government so much. I never expected to come back again, this is my second tour of duty, but I have just absolutely loved it. And then personally, it's such a pleasure to be able to work on the programs that I was able to benefit from as a child. So for me, it motivates me. I find it very exciting. And I think that for those who are in research and that choose to spend some time in government, I truly think it will make you a better researcher, because what it will teach you is that not every important question is urgent, and what are the urgent questions on which you should really focus your energy.   Speaker Bio   Sara Bleich, PhD was named Director of Nutrition Security and Health Equity for the Food and Nutrition Service in January 2022. Since joining the Biden-Harris Administration in January 2021, Bleich has served as Senior Advisor for COVID-19 in the Office of the Secretary. Previously, she served as a Professor of Public Health Policy at the Harvard T.H. Chan School of Public Health. Her research centers on food insecurity, as well as racial injustice within the social safety net. She is the author of more than 150 peer-reviewed publications. From 2015-2016, she served as a White House Fellow in the Obama Administration, where she worked in USDA as a Senior Policy Advisor for Food, Nutrition and Consumer Services. Bleich holds a PhD in Health Policy from Harvard University and a bachelor's degree in psychology from Columbia University.  

Today's podcast is part of our Regenerative Agriculture series. I'm speaking with Mark Muller, Executive Director of the Regenerative Agriculture Foundation (RAF). The RAF seeks to foster the economic policy and knowledge conditions that support land stewardship, climate solutions, racial equity, adjust economy, and thriving rural communities. Interview Summary   So Mark, your paths and mine have intersected over the years in very pleasant ways, and I've admired the work you do. And when you went to work with the Regenerative Agriculture Foundation, I thought, "Boy, this is a perfect match." And I'm so happy that you and the Foundation are part of the same picture now. So I'd like to ask, first if you could tell our listeners about the Foundation, and what does the organization hope to accomplish? Because the Foundation itself says that regenerative Ag is not a new idea, that it's difficult to define, it's grounded in community, and it's a journey. So I'd love to hear you explain how all this comes together into a coherent idea.   So the Regenerative Agriculture Foundation, we are an intermediary funder, which means that we received grants from RV Family Foundations. Our founding entity was the 11th Hour Project of the Schmidt Family Foundation. And the idea is that we can utilize those funds more efficiently by having a solid knowledge-base of what's going on - on the ground in regenerative Agriculture. And so that we can re-grant those dollars to be more effectively used around the country. I was brought on about 18 months ago with the intention of trying to diversify our funding, to continue our great relationship with 11th Hour Project, and then to find other funders to step up in a bigger way. And I'm thrilled to have several that have joined. And what I really like for us to do is be the bridge between the nonprofit community, and the funder community. And trying to find different ways that we can all work together more effectively, to move advanced regenerative Agriculture.   Is the concept of regenerative agriculture nebulous and difficult to define? Does the field kind of agree now on what it is?   I noticed a couple of podcasts ago you had a great conversation with Samantha Mosier around this topic. In my mind, and the reason why on our website we talk about it being a journey, is because it is such a difficult to define concept. And there is a lot of pressure, from an industry and a marketing perspective. You really want to have a clear definition, like what we have for organic. In my mind, I am comfortable in the discomfort of not really having a clear definition. And what I feel like is it is a little presumptuous of us to think that we can define what a truly regenerative Agriculture is. It is a journey that we're going to continue learning about, and there are steps that we can take. And it appears that there are practices that we can document saying, "Yes, these appear to be pretty strong regenerative practices, but we have an awful lot to learn in terms of what a truly regenerative landscape is, and how agriculture fits into that. So I prefer to talk about it as a journey, and not like a specific destination that we know that we're going to.   We've recorded a number of podcasts thus far with some farmers and ranchers who are living this day-to-day, with some scientists who have been looking at it, some people who pay attention to the policy part of it. And I know your Foundation will incorporate people who do all those sort of things. So let me ask kind of a big picture question then. So how do you think the regenerative agriculture can become part of the solution for addressing the climate crisis?   Yes, great question. One of my motivations is to try to figure out how regenerative Agriculture can be recognized as a key part of the solutions that we need to have to address this climate crisis. And agriculture has come up quite a bit right now, the Glasgow COP meetings are going on. And one of the issues that I'm really trying to highlight is that regenerative Agriculture can do a very good job of sequestering carbon, and providing those benefits, in terms of reducing the amount of carbon dioxide that we have in our atmosphere. That is one of the many benefits that we can receive from a truly regenerative Agriculture. And what I feel is undercounted is the benefit that can be provided through providing a more resilient landscape. We know, regardless of how well we do over the next decade on mitigating greenhouse gas emissions, we are dealing with a climate crisis that will continue to get worse. We need to have a landscape that could be resilient to the flooding, and the droughts, and the other impacts that will be happening. A truly regenerative Agriculture can provide that. And so part of the reason I'm trying to look at regenerative Agriculture as, yes, incorporating practices on our existing crops, such as corn and soybeans here in the Midwest. And, however, to get to the truly resilient regenerative Agriculture, we need to have a far greater diversified landscape. We need to have more perennials on the landscape, there are many other things that need to happen. But by doing that, we can be part of the solution, both for the mitigation of greenhouse gases, and then also for the resiliency that we need to have in our landscape.   So you mentioned the international climate meetings that have occurred recently in Scotland. I'm wondering if you happen to know how much agriculture was discussed in those meetings, and whether regenerative agriculture had much visibility?   Yeah, it is discussed. I have not attended that meeting, but I can't say that I'm paying as much attention as I probably should to it. But agriculture is obviously a key component, both for the economic reasons that it's such an important driver for so many economies. And then also for the landscape impacts of it, that agriculture is the primary way that we use much of our landscape. But I would say overall, the conversation has tended to be much more around power production, and then transportation and buildings. And down the line, we eventually get to conversations about agriculture specifically. And because of the reasons I mentioned about the landscape benefits from a truly regenerative Agriculture, I do believe and I do hope that it will become a much broader part of the conversation as we move forward.   So if you ask the public, what kind of things are contributing to the climate change, my guess is that not a lot of people will mention agriculture. It's a growing number, for sure, there's increasing awareness, but my guess is it's not a big percentage of people think about that. And they do think about transportation, and coal-burning power plants, and the generation of energy and things like that. Do you see any shift in public opinion, and what does that look like to you?   Yes, I believe that there is more recognition of perhaps the larger food system, and the impacts of the food system that it has on climate change. If we look at the entire food system, including the processing, the production, the transportation of the grains and the foods, we are a very large chunk, some estimates around 30%, of the entire greenhouse gas emissions output. I do believe that's getting more widely recognized as the concerns about climate change increase. And for those of us in the regenerative Agriculture sector I think there's a lot of excitement about how much can be reduced by having, not only regenerative Agriculture on the field, but also more regenerative economic systems that surround agriculture.   I agree, I'm optimistic as you are on that front. So let's get back to the Foundation. So I know the Foundation is focused extensively on racial equity over the past few years. So why is that what are you doing?   Yeah, that is a great point. And I have to say, when I started this job about 18 months ago, I came in thinking, "Oh, it'll be really nice if we could put in a stronger racial equity lens into regenerative Agriculture." I live in south Minneapolis, and so obviously the events surrounding the murder of George Floyd really kind of shook many of us up, in recognizing, for me, it felt like, "I'm not sure if it's just a nice thing to put racial equity into regenerative Agriculture." It has to be completely infused in it. And we cannot get to a truly regenerative system without not only providing the healthy soils and clean water, but I do believe that the farm worker justice, and racial equity lens, and the really hard conversations to have about land ownership, they have to be part of the component too. Part of the reason I say that is because when we looked at what happened here in Minneapolis, and we looked at what happened to our public safety systems, these systems break down if we ignore these racial equity issues for too long I can't help but look at our agricultural landscape, and see that we have somewhere around 96% of the land is operated and owned by white farmers and land owners. It's an untenable situation. And so I do really strongly feel that we need to provide a way of addressing this issue, just as much as we have to address these soil and water issues that we have.   So Mark, tell me about restoring regenerative agriculture?   Yeah, this is a program that I'm thrilled about. And I have to say I was so impressed by the REF Board, when we started having conversations about how we can infuse a greater racial equity lens. They set aside what would end up being $500,000 for grants to organizations that are led by Black, indigenous, and people of color. We started the process of looking how we would do that. And I have a lot of gratitude for a friend of mine, Brett Ramey, who's with the Iowa tribe of Kansas and Nebraska, and Brett agreed to help us with this process. And Brett really kind of hammered on the importance, of not only the distribution of funds to these BIPOC organizations, the importance of having a participatory grant-making process, and having the decisions made by a committee of Black, indigenous, and people of color. And so we went through this process, it was far longer than I had thought, I really wanted to get this done in a couple months. And it took, well, a good eight, nine months for it all to happen. And it was a far better process, because we did really infuse the decision-making process to be of all people of color. The process was called restoring regenerative Agriculture, and that was brought up by the selection committee. In part because there was some real tensions about the term "agriculture" in many indigenous communities. The restoring regenerative Agriculture, it really emphasizes that regenerative Agriculture is in part, the great stories that we've heard over the past 30 years, of largely white farmers that have been really innovative, and learned how to incorporate systems that reduce chemical use and increase yields. And there's a much longer story to be told about how traditional ecological knowledge was a key component of that work. And there's a much broader story to be told about how these efforts have taken place in so many communities; indigenous communities, African American communities, Latino communities. There is a lot of knowledge being built and utilized throughout, that is much broader than what we normally think of as regenerative Agriculture. And our hope is that this granting process continues this process of us thinking more broadly about what is truly regenerative Agriculture.   I'm not sure I'm using the right word here, but it almost sounds celebratory, that there's a celebration that the practices used in the past, going way back to the very beginning of our country, were important. They were ecologically sound, they were good for the environment, good for human health, and now they're getting rediscovered. And that that should be celebrated, rather than saying, "Oh, this regenerative Agriculture is a new thing."   Yes, I think you said that well, Kelly. It is, hopefully is, a celebration of the thousands of years of innovations and creativity that have taken place on the landscape, and a way of honoring and promoting a continued use of innovation by all sorts of different people. I always get frustrated when we talk about innovation as being inside of the seed companies, and the large corporations that are involved in agriculture. They do have a role in innovation. There is far more innovation opportunities in the small-scale farmers that are using innovative practices, that are really listening to the land, really listening to how the plants are growing. And I also have to say that there's a lot of opportunity in these farming communities that have traditionally been outside of the commodity system here in the United States. As we know from some of the historical racism that we've dealt with, many African American farmers have been excluded from the corn, soybeans, wheat, cotton, rice; the primary commodities that we have in the United States. And thereby have had to be incredibly innovative, in terms of how they grow, and make a living off the land. Honoring that innovation, and celebrating what has happened, and incorporating that into our broader perspectives, provides an awful lot of opportunity.   So Mark, you spent a good bit of your career dealing with policy-related issues, and have been a real leader in that arena. So let's talk about the Farm Bill. So organizing around the Farm Bill is beginning in earnest for the anticipated 2023 reauthorization. So what do you think are some of the key issues regarding regenerative Ag?   Yes, and I do remember, I believe I first met you, Kelly, when we were having some conversations about US farm policy in the Farm Bill, and the impact on public health, as we are learning more and more. So it is such a broad system, it has so many impacts on so many parts of our society. So for this forthcoming Farm Bill, one of the issues that I had been focused on is the conservation title of the Farm Bill is the second largest title. The largest program in the conservation title is something called the Conservation Reserve Program, sometimes called the Set Aside Program. And we have taken up to 40 million acres of land out of production to provide conservation benefits. I have always had very mixed feelings about this, and I have to say, in full disclosure, I am part owner of a family farm in Dubuque, Iowa, area. And we are in the CRP programs, so I benefit from this program. However, the challenge is it doesn't change how people farm, it doesn't create a pathway for farming more innovatively. What it really does is rewards farmers for putting in conservation practices, taking aside, putting in grasses, things like that, to provide wildlife benefits, water quality benefits. But often what happens after the 10-year program, the farmers put it right back into the same corn and soybeans that it has been in, without changing those practices at all. So I'm particularly interested in finding the programs in the Farm Bill that don't just provide some temporary environmental benefits, but actually provide long-term changes to how we farm. And thereby sequester far more carbon in the system long-term, provide much more water quality benefits and things like that.  

So there's much talk these days about weight stigma, in fact, we recorded a number of podcasts ourselves on the topic, and I believe it's very important, but this is our first podcast on another form of stigma. One that is powerful, often overlooked, and highly important to address. Our guests today are Matthew Garza and Nick Cuttriss. Matthew is Managing Editor at The diaTribe Foundation. And the dia in diaTribe derives from diabetes. The foundation's mission is to, and I'm quoting here, "to improve the lives of people with diabetes, prediabetes, "and obesity, and to advocate for action." I've served on an advisory board for diaTribe, and very much admire their work. Nicolas Cuttriss is a pediatric endocrinologist, and is founder of the ECHO Diabetes Action Network, and also has served on an advisory committee for the diaTribe Foundation. Matthew and Nick have been integral to a novel and welcome program on diabetes stigma that launched recently, that can be seen at the website, dstigmatize.org. Interview Summary   So Matthew, let's start with you. So can you explain what is diabetes stigma, and how does it relate to stereotypes around food and obesity?   Mathew – Absolutely. So in general, we know that stigma refers to the experiences of exclusion, rejection, prejudice, that blame and shame that people unfairly experience based on some characteristic or perceived difference. And in this case, that's diabetes. And this might look like negative attitudes towards people with diabetes. It might be hurtful or insensitive jokes made at their expense. And in some cases, it can even be outright discrimination. While there are many forms that diabetes stigma can take, such as being singled out for wearing a visible diabetes device, like a continuous glucose monitor for example, or an insulin pump, it could also be the stigma that's associated with having a chronic condition that does require, in some cases, daily medication. What we're seeing is that most of the research actually shows that the bulk of the stigma associated with diabetes stems from the misunderstanding that poor choices and unhealthy behaviors are the sole cause of this condition. And that people who have been diagnosed with diabetes somehow brought it on themselves. And this is attributed to both people with type 1 and type 2. And the stigma comes from lots of different sources. So it can be external from the media in shows or on the news. It can come from your friends and your family, from coworkers, healthcare professionals in a clinical setting. And sometimes it can even happen within the diabetes community. We often see that in defending themselves from the harmful stereotypes associated with diabetes, that people with type 1 can sometimes unintentionally redirect that stigma back onto people with type 2. And in regards to how this form of stigma specifically relates to food and obesity, it really goes back to what I was saying that unless you have diabetes or unless you know someone close to you that has diabetes, a lot of time, your only real knowledge of the condition is that it's connected to eating too much sugar, right? Or eating too much junk food, and that that somehow caused this. And a lot of times, it's associated with obesity or having excess weight. And then, on top of that, especially in America, we have this culture that there's this really problematic assumption that health is primarily a matter of individual responsibility. And this creates this stigmatizing narrative that blames people with diabetes for bad choices, and it sets up this us versus them. And it makes us treat people with diabetes differently because somehow they did this to themselves. But all of these beliefs oversimplify this really complex biological condition. And it overlooks all of those other, the systemic factors, such as environmental and socioeconomic context that people live in. Their access to healthy food options, to healthy grocery stores, for places to exercise. And so the more that we can kind of separate out diabetes from these misconceptions about food or sugar being its only cause, I think it's the better that we can support people and make sure that everyone is getting the care that they deserve.   Boy, have you painted a detailed picture of that and I appreciate it, and I can imagine that navigating this world of stigmatizing events must be especially difficult for children. But let me ask you, overall, what are the negative impacts of diabetes stigma?   Mathew - Absolutely, so there's so much research that I think still needs to be done to get a picture of the prevalence, the impacts, and the interventions that can address diabetes stigma. And thankfully, we've had some really great leaders in the field who have started to lay the groundwork to show all of this. And we see that diabetes stigma, and especially the language that we use to talk about diabetes has extremely negative effects. People with diabetes report feelings of fear, embarrassment, blame, anxiety, low self-esteem as a result of experiencing stigma. And this can translate into really harmful mental health conditions such as depression or higher levels of stress that drive unhealthy behaviors and can increase a person's risk for developing even greater health complications. You know, I know that Rebecca Puhl has touched on this a lot in her research on weight bias that we have this idea that potentially having this stigmatizing attitude will somehow motivate people. And in this case, motivate people with obesity or excess weight to improve their current habits. But actually, it has the opposite effect, and it causes things like harmful disordered eating or leading people to avoid physical activity altogether. And in the same vein, we see it happening with diabetes as well, that the stigma associated with the condition actually leads to worse self-care and worse diabetes management. So for example, we've talked to people, and seen in the research that they report injecting insulin only in public restrooms or at home, that they might choose to make an unhealthy food choice to avoid declining what is being offered to them. And even manipulating their glucose logs or lying about the management that they're doing just to avoid criticism from significant others or from healthcare professionals. And specifically, when the stigma is from healthcare professionals, it can actually inhibit people from seeking the necessary care that they need. One of the really concerning things that we've seen recently is that the research shows that people with diabetes fear being exposed for having diabetes or being labeled as disabled. And it discourages them from being open about their diagnosis in a way that is also influencing those who might be at risk, because it's acting as a barrier overall to awareness about the condition and to prevention. And it's increasing those feelings of isolation right after a diagnosis. And so the sheer breadth of all of these negative effects is why we believe that addressing diabetes stigma is such an essential missing element of effective diabetes care.   Well, in a very short time, you've mentioned a number of very troubling consequences, and you can see how these things would feed on each other and you'd have this cascade of negative effects that could really impact just about every part of a person's life. So Nick, let's turn to you. So research on both diabetes and weight stigma has shown that people often report feeling stigmatized in healthcare settings. So what experiences are common in these settings, and how can healthcare professionals advise people on the relevant issues like lifestyle change without making stigma worse?   Nick - So Matthew touched on it earlier in terms of stigma around when people are diagnosed with diabetes, they are blamed and shamed “that it's your fault.” But then, it's also perpetuated after diagnosis, and healthcare professionals putting blame and shame on patients for, quote, "being uncontrolled." And there's a marker, the A1C, which many healthcare professionals use. And we report EDIS rates in terms of quality improvement. And A1C less than 9% is how the health system separates out between people who are, quote, "controlled or uncontrolled." And the majority of people living with type 1 diabetes and type 2 diabetes have A1Cs that are greater than 7%, and they're not able to meet the targets. And so we, as healthcare professionals, need to become more explicit in working to overcome these implicit biases we label our patients as uncontrolled and perpetuating this stigma. A couple examples of what we can do in the healthcare professional setting is focusing on our language. And diaTribe has a great resource on their website, or you can look at the dstigmatize.org website to watch a couple video clips and really understand how language matters. So not labeling someone as diabetic, but they're a person living with diabetes before diabetic. They don't have good or bad blood sugar control. Their numbers are high, their numbers are low. Using descriptives, not saying, "Let's test someone's blood sugar," but checking someone's blood sugar. They're not on trial for their diabetes. And I think us as healthcare professionals need to realize when the majority of people living with diabetes aren't able to meet targets, it's not their fault. It's our fault. It's the delivery of healthcare that's failing, and it's not the patients who are failing. And we need to be more empathetic to them. And then, when it relates to obesity, similarly, when almost 50% of adults in the US are obese, and more than half are obese and overweight, we need to stop labeling them as obese and their fault when it's the majority of people who have this. I just had a colleague in the healthcare professional arena come to me last week, he said, "Nick, you know what? They put obesity on my diagnosis, I'm so upset." And this is someone who is trying to address their weight and get newer medications that help address the weight. But the healthcare professionals said, "No, you need to try more." So I think we need to change our approach of how we label our patients, and how we approach them with this blame and shame.   Well, and it's easy to see how people who feel stigmatized and have difficulty in the medical settings with the healthcare professionals they're interacting with would be more likely to avoid care, and that could exacerbate their condition. So let me ask this, do you see any signs that this issue is being addressed in the medical profession? Does it come up in med school training? Is it part of continuing education? Is it on the radar anywhere?   Nick - I wish it was more systematically. I think maybe at some institutions where there are champions for people living with diabetes, where a student might get a lecture, but unfortunately, I don't see it there. And I think that's what's so exciting about diaTribe dStigmatize initiative is really to get more broader reach and get the basics. So in medical school, we get into all these details in terms of cause of diabetes and medications. But I think if we could just back up on the humanistic level and know how to talk to people with chronic conditions, we'll train the next generation of leaders much more humanistically and have better outcomes if we can focus on the basics of how to interact with people living with chronic conditions, and getting rid of this blame.   It sure would be nice to see some of those things happen. So I'd like to ask a question of both of you. So it's clear that addressing diabetes stigma is a complex challenge. So what does diaTribe think needs to happen to begin combating this problem? And, Matthew, let's start with you.   Mathew - Thank you both so much for mentioning dStigmatize; that's what we're really excited about. We just launched this online resource that we hope is going to be the first step, because when we started to look at what is the landscape of resources out there for someone who wants to make sure that they are able to understand what the problem is and how to address it, there really was no centralized location. So what we wanted to do is bring resources together to make it a one-stop shop that anyone who wanted to learn about how to identify this form of stigma, why it might be harmful, or hear the real life stories from people with diabetes, about their condition, and about how stigma has affected them, that they would be able to do that in this one place. And we launched this resource primarily because we think that there's two very essential first steps that we need to take. And the first is that in order to address this public issue, we have to shift away from that really pervasive blame and shame mindset, right? So we want to reframe the way that people are thinking about diabetes, so that it's viewed as this complex, but manageable condition that nobody asks for. And not that it's somehow a failure of personal responsibility. So part of that has been that we've been really grateful that so many members of the diabetes community have been so open to sharing their stories because it's really helping us paint a picture of what diabetes actually looks like, and the ways that stigma affects people on a day-to-day basis. And then, the second part that our website really addresses is that language. And so leaders like Jane Dickinson, Susan Guzman, and Jane Speight have all been really key in making sure that language is seen as one of those tenets when it comes to addressing diabetes stigma, that the words that we're using to talk about diabetes currently lack that kind of awareness, and consideration, and even empathy at times. But because language matters and it has real impacts on the way that people with diabetes view themselves, how healthcare providers view people with diabetes, and how the general public views them, we wanted to create very specific language guidance directed at people who might write, or talk, or communicate about diabetes in some way, that encourages them to use words and phrases that are neutral, that are nonjudgmental. And at its very core, that are based on the facts, and actions, and physiology or biology that can actually help people, right? We want to get away from using all those terms that Nick was talking about like bad glucose levels or controlling their diabetes, because those just aren't actually factual when it comes down to it. Looking forward, dStigmatize is just the first step. We think that there's so many other initiatives aimed at getting more research funding to really explore this issue and its impacts. We think that there's the potential for media advocacy campaigns, similar to what GLAD did at the beginning of the LGBTQ Civil Rights Movements in addressing the negative representation of people who are LGBTQ in the media that a similar thing could be done because there's so many negative portrayals of diabetes and inaccurate portrayals in the media. And then, finally, the campaigns that influence the general public's attitudes towards diabetes. One of the key next steps might be influencing healthcare providers' interactions because like both of you said, we know that the research shows that this is a key area where people are experiencing stigma. And this is also a group that I think truly wants to make sure that their patients are feeling empathy, and that they're able to help them in any way that we can. And so I know that this actually is a very specific intervention that Nick has been doing a lot of work around and can speak to the importance of.   It's a very comprehensive effort you're discussing. So Nick, what would you like to add to that?   Nick – Yes, so, I'm a hyperspecialist in pediatric endocrinology, and there's just not enough adult endocrinologists or pediatric endocrinologists to care for people living with diabetes. And we just need to recognize that frontline healthcare professionals have more of an opportunity, more touch points to make a difference than a specialist like me. And we really must do everything to support frontline healthcare professionals in overcoming diabetes stigma. So as founding director of the ECHO Diabetes Action Network formed to combat system failures in our society in how we educate clinician and approaches to medical management for people with diabetes. And we're seeking to democratize diabetes specialty knowledge, so they can reach frontline healthcare professionals and power underserved populations living with diabetes. So an example of the efforts to target frontline healthcare professionals and improve care, we've launched a monthly educational series focusing on diabetes and disparities in the primary care setting. And then, the initial focus was attention to CKD and diabetes, and we're going to be moving focus areas moving forward. And we'll do a block on cardiometabolic issues, and obesity-related diabetes disparities. And then, also, we'll collaborate with diaTribe on launching one for addressing diabetes stigma and behavioral health, just to name a few. So for more information, feel free to visit echodiabetes.org, and join us for being a champion for people living with diabetes in the primary care setting.   Bios   Matthew Garza is the Managing Editor of DiaTribe. Matthew Garza joined the diaTribe Foundation in 2020 after graduating with honors from Johns Hopkins University's Whiting School of Engineering where he majored in Biomedical Engineering and minored in the Study of Women, Gender, and Sexuality. As an undergraduate Matthew was heavily involved in research, working in the Hopkins Translational Tissue Engineering Center. His research focused primarily on stem cells, three-dimensional matrix scaffolds, and surgical outcomes for transgender patients. He has a passion for understanding more about the socioeconomic determinants of health and how they affect health outcomes, primarily for the LGBTQ population. Matthew swam for the Hopkins varsity swim team and was the president of the Student Athlete Advisory Committee and Hopkins's Athlete Ally chapter. He enjoys swimming, running, hiking, and backpacking in his free time and he will never turn down the opportunity to eat good food or listen to good music.   Dr. Nicolas Cuttriss is a social entrepreneur and a practicing pediatric endocrinologist and public health professional with a unique dedication to health disparities and improving the quality of life of people living with diabetes. He currently serves as Founding Director and CEO of the ECHO Diabetes Action Network after serving as Director of Project ECHO Diabetes and Project ECHO Diabetes in the Time of COVID-19 at Stanford University. Prior to joining Stanford, Dr. Cuttriss served as the first pediatric endocrinologist for the University of New Mexico Project ECHO Institute ENDO teleECHO clinic to democratize diabetes specialty knowledge by empowering primary care providers to care for patients with complex diabetes who lack access to routine diabetes specialty care. Clinically, Dr. Cuttriss founded and serves as Medical Director for ENDO Diabetes & Wellness, a medical practice specializing in diabetes and telehealth where he also supports and consults with medical groups and hospital systems around the country to address barriers to routine diabetes specialty care. Dr. Cuttriss also serves as co-Founder & Chairman of the Board of AYUDA (American Youth Understanding Diabetes Abroad), a 501c3 global health volunteer organization that empowers youth to serve as agents of change in diabetes communities aboard.

Today, we're going to explore one way that young people in North Carolina are working to improve their local food system. The Food Youth Initiative is a program based in the Center for Environmental Farming Systems, which is housed at North Carolina State University. Now we'll be talking with the Program Coordinator, Bevelyn Ukah, and the Program Partner, Ree Ree Wei, of Transplanting Traditions Community Farm. Interview Summary   Great, well it's good to have you, and as I was explaining before we actually went live on this, we've done, I don't know, 150 podcasts or so, but this is the first one that specifically deals with youth in the food system and the role they can play, so I'm really happy to hear from you about what seems to me to be a very innovative program. So, Bevelyn, let's start with you. Can you tell us what the Food Youth Initiative is and talk about your work there?   Bevelyn - Yes, the Food Youth Initiative is a program of the Center for Environmental Farming Systems. It sometimes challenges me to call it a program, because it's more so a network of youth groups across the state that are doing food justice work in their areas. So as the Network Coordinator, my job is being in relationship with them, listening to the work that they're already doing in their own communities, and finding as many ways as possible to make sure that they're connected to each other's work. All the youth groups that are a part of the network, about eight now, are all doing various things that are connected to the food system. What makes it that much more powerful is when they come together because they're able to exemplify different entry points on what food, and food systems, and food justice looks like.   You know, community organizations are very often doing quite creative work, but work in isolation and don't get the chance to connect up with other community organizations to share ideas, and strategies, and things. I'm imagining this is a very powerful experience. Have you found that to be true?   Bevelyn - Yes, I have found that to be true. And I would love for Ree Ree to answer this question as well. It's always awkward when bringing people together. And youth tend to be super honest about how they're feeling in their bodies. So when bringing these youth groups together from these different walks of life, the first day or the first few experiences are a little bit awkward. And it's one of the most powerful witnessings that I see over and over again, how a bit of time and a bit of tools and resources can get people talking and moving. How it completely shifts the trajectory of how these youth can learn from one another. I think that the first step in bringing youth together is to make sure that there is a validation that the work that they're doing is innovative. And the work that they're doing is important. That it actually pushes against the grain of how the rest of food systems work looks. And once we start to name that and identify that, it's super powerful in terms of the transformation that takes place when youth come together.   Thanks for that explanation. Ree Ree, I'd love to hear your thoughts on that. It sounds like something pretty magical happens when the youth from different groups get to come together and share things. Has that been your experience, too?   Ree Ree - Yes, that has in my experience. Being part of FYI, and I started out as a youth with Transplant Traditions Community Farm back in 2013, it was very new. And very awkward, and very weird to be able to be in a space of I want to do something as a youth, but I feel very uncomfortable. But over time, having that physical connection, being able to see each other in person, and network, and share out changes perspectives, and youth confidence and youth visions for their future. I can say that I am a testimony to the work of FYI and TTCF Youth Program. I have learned skills that are beyond what I thought that I needed. Over time, I built a lot of skills and learned why my voice as a young person matters. Why collective working together matters, and that is unique about this. One youth group inspires another youth group, and different food systems and food justice work, it's very interconnected.   It's nice to hear from both of you on your perspectives on that. Ree Ree, let me ask you a follow-up question. I know there's a lot of interest in this concept of youth justice, and how does youth justice connect to food and environmental justice?   Ree Ree - Yes, there are these expectations and societal norms that youth are supposed to do this, and this, and this, and that. And sometimes adults and even society put youth in a box. But when we were talking about youth justice, we are able to create a space for them. And that's what FYI is really good at it, and being able to be say, "Okay, we are going to work on food justice or environmental justice," and, "Here, this is your space." And food work gets to be creative. They get to come up with things they want to do, and giving them the autonomy for them to be able to say, "I want this, because I see this, and this is what I can do," even though this youth might feel like they're unable to do it, but over time, that space, giving youth that autonomy, oftentimes there's not room for youth to be able to do that. And especially the work that FYI does and Transplant Tradition do is that we centers around where youth are able to have the decision making of how they want to strategize about this project. What goes on this picture, that type of thing. So when youth are given the space and the voice, they're able to see the connection between food and environmental justice and how work that they're doing is not just on a surface level; it goes deeper and they're connected. Youth are able to address these different generational issues that their ancestor experienced.   You're giving voice to something really important, and I could see how this would be such a powerful experience for the youth that you work with. And let's talk a little bit more about the particulars of the program. So Bevelyn, I know that one part of the project overall, the initiative is the Mural Project. Would you describe what that's about?   Bevelyn - Bringing youth together is the important part, but the strategic planning that we put into the process of how we bring youth together is really important. And our theory of change acknowledges that for systems change to be possible, we need to work on multiple levels, including a policy level. We need to be able to educate ourselves and our communities through storytelling and other forms of expression. We need to be able to act and create models or create spaces that offer this reimagination of how our food system and our society should look like. And as we've been talking about, it's also important for us to build relationships and to be able to maintain those relationships, because ultimately what we're trying to create or continue is an ecosystem that brings a sense of belonging, for not only the youth participants, but also for the communities in which they live.   And so the Mural Project is heavily connected to the education part, the storytelling part of our theory of change. Every year, when we bring youth together, there are multiple skills that are being developed. We've focused on storytelling from different mediums and different forms. In the past, we've done photography and made sure that youth had access to really nice cameras, and that they could go around their communities and take photos. And they had a few exhibits. We also created a traveling exhibit for the youth to be able to own this exhibit and be able to use whenever they're doing presentations. We've worked on public speaking in the form of learning how to write monologues and sharing them. We did that at the Durham Art Council some years back. We've done a whole compilation of poetry and worked with a poet who worked with us for a whole week. And so right now we're creating a mural that is centered around community stories, around food and environmental justice. We have youth coming from Transplanting Traditions, and Chapel Hill, Pupusas for Education, which is based in Durham, and then A Better Chance/Better Community, youth and adult allies are coming together to form this experience.   It's an eight-month project where they have been learning about one another, relationship building, but also building their knowledge base on the root causes of food injustice and lack of accessibility to healthy, culturally relevant food, and also learning about root causes of climate change in ways that we can galvanize ourselves to shift this narrative, to be more connected to our natural environment and to be more ecologically conscious. That was a first phase. And the second phase we're in right now which is where youth are gathering together in Durham over the next three months to work on a storytelling project, get to know one another, but to work on a storytelling project where they will be going out into the community and creatively offering opportunities for people to talk about their experiences around climate, environmental justice, and food. They will bring those back to our hive, I guess I'll call it, in forming, designing a mural that expresses those stories and that mural will be on a food truck. Pupusas for Education has offered a food truck for us to paint on over the next few months, and it will be unveiled on June 11th at Transplant Traditions Community Farm. And I will say that that unveiling will be a party and everyone is invited.   That sounds so lovely. I can imagine how meaningful an experience this would be to the youth. The food truck idea is a really good one. Yeah, I can't wait to see this. It just sounds so neat.   Bevelyn - Yeah, we're really excited about being able to have a mobile mural that people can see all over the place. It's more accessible this way.   It represents a collective effort of a lot of different people, so it just sounds so nice. So I'd like to ask both of you kind of a follow-up question, and, Ree Ree, let's start with you. What kind of impact do you think the youth are having in their communities?   Ree Ree - Sometimes they feel like they don't, but it's a huge impact. They are the voices and they're the ones that are speaking up and publicly saying it out loud to the community that these issues are important, and they're being impacted at a very young age. And they're even impacting folks directly or indirectly one way or another. Like our youth group, they are doing tutoring, and they don't realize that is a huge impact to the direct causes of literacy issues. And the other bigger impact that they're having is they're addressing things that not many people are aware of, like food justice, environmental justice, climate just- Like why are we changing the narrative from seeing things as an issue to, "Okay, it's an environmental problem." Now let's flip the narrative to, "Okay, we're fighting for environmental justice or food justice." They are using their own voices and their bodies, and being able to say, "We are doing this work and we need you all to listen to us because these issues are going to continue."   You know what it reminds me of is the early days of seat belts, where there were a lot of adults that were reluctant to wear seat belts, but education programs started happening in schools. Youth then came home with the message, and adults were listening to the pleas of the youth to wear seat belts, and it really made a difference. And I could see that same thing kind of happening here. Bevelyn, does that make sense to you, and what kind of impact are you seeing youth having in their communities?   Bevelyn - I think that's a really great example, the marginalization of youth voices. It's very intentional. Historically, anytime there's been large-scale transformations, those societal transformations have been led by youth. For social transformation, younger generations have the juice. I think it's really, really important for youth to be able to share their own stories and talk about what they're doing. And at the same time, part of my job is to share as much as possible the actual activities, the actual things that youth are doing to shift our food system. So earlier, when I was talking about the theory of change, when I was talking about policy, education, replicable models and networks, I was more so speaking from the perspective of how we're building out our programs within the Food Youth Initiative, but ultimately, each of these youth groups are already working in their communities on all of those levels to make changes. And one example is Poder Juvenile Campesino. They've been doing a lot of work on farm labor rights, specifically building awareness around the challenges, not only that farm workers experience, but that farm worker youth experience, as our policy in the United States allows for children to be in our fields with very little protection. A lot of these youth are farm laborers themselves, and so they're not just advocates. These experiences directly impacts them and their families. And then Ree Ree's already talked about education and storytelling. Transplanting Traditions youth have been heavy advocates for the farm and for the farmers, as a lot of the farmers may have challenges around speaking English or even accessing certain systemic resources. And so, to be able to openly talk about the importance of recultivating home in the United States in Chapel Hill, that story has heavily been told by the youth of the farm. I can go on and on about the replicable models and networks, but I just wanted to be super clear that we're not just throwing these words around, climate justice, food justice, environmental justice, that the youth that are a part of this network are doing groundbreaking work in their communities. So I heavily encourage folks to continue to follow us so that you can continue to educate yourselves about the high impacts work that is being done.   It sounds like with the youth having voice and carrying messages forth is important to both the people who are speaking the message and the people who are hearing it, so you can see really important impact occurring with this, couldn't you?   Ree Ree - Yes, and I see in some ways, like something I have learned being part of the youth program that I have learned over time, is that the impact is both on a personal level and also at the big P, on a policy level, on a public level, so it impacts folks directly and indirectly in a way where it leads to cool things, like being able to address for policy changes. And they're able to learn how to advocate for themselves personally. So that's sometimes the impact that sometimes people don't often realize, youth also are learning how to advocate for themselves, which is like big things that, and especially a lot of youth that we have worked with and learning about you are able to advocate for yourself, you have that autonomy. Especially for BIPOC youth and being able to empower them, just tell them, "You can do both of these on a personal level and on a policy level."   So one final question for you both, what sort of support do you need to continue this kind of work? Bevelyn, how about you first?   Bevelyn - You mentioned earlier that there hasn't been a direct interview about youth in the food system. I believe that there's little awareness about the impacts that youth make on our food system. And therefore there are minimal resources for continued programming and continued network development around youth, and so I'm looking to do more intentional work around fundraising, as opposed to grant writing, because we're able to have a lot more freedom to support youth needs and to be able to identify blind spots that I think that grant makers are having in the process of creating financial opportunities for youth to be able to soar in this work.   And Ree Ree, what about you? What do you think? What kind of support is needed to continue this kind of work?   Ree Ree - Yeah, I think the type of support that's needed is from all kind of level, being able to, one, like listen to youth. Oftentimes adults have biases about youth. Listen to them, listen to their story, make time, being very intentional about learning about what youth are doing and giving time for that instead of making judgment. And the other thing is to follow the different youth groups of all of FYI network. It'll be really cool to be able to see what they're up to and why their work are, and it's very unique in a way that they're addressing these social issues on a local level. And the other thing is that all of our youth group, they're doing these intentional work that sometimes staffs are limited. We rely on volunteers and contractor peoples to be able to really do these meaningful work, to really continue to support and uplift youth, so on a fundraising level, to support that and reach out and donate.   Well, thank you both for being with us. This work is really exciting, innovative, and I'm glad that we can play a role in letting our listeners know about it. So, thanks so much for being with us.   Bevelyn - So, Ree Ree's really humble, but Ree Ree was 13 when she started with Transplanting Traditions, and about 14 or 15 when she was one of the co-founders with other youth groups of the Food Youth Initiative network, and essentially she hired me. I applied for the job and she hired me at maybe 15 years old. She went through the program, went to Guilford College, studied Human Relations, came out of college, and is now the ED at Transplanting Traditions. And so I just wanted to also name that career trajectory, that to me is so powerful of how when youth are supported and when they have intentional relationships, how many possibilities open up to young adult's leadership within these powerful food justice spaces.   For more information about the Food Youth Initiative: https://cefs.ncsu.edu/youth/food-youth-initiative/   Bios:   Bevelyn Afor Ukah works as a consultant to train youth and adults in building skills that encourage equity, organizational efficiency, cultural connection, and collaboration. She coordinates the Food Youth Initiative Program (FYI), a program of the Center for Environmental Farming Systems (CEFS), which engages youth that lead food justice work across North Carolina. She also co-coordinates the Racial Equity in Food Systems initiative at CEFS, which develops a shared understanding of language, history and race.  She serves on the Transplanting Traditions Community Farm Board, the National Rooted in Community Board and the NC Climate Justice Collective.    Ree Ree Wei is the Executive Director of Transplanting Traditions Community Farm. She moved with her family from a refugee camp in Thailand to South Carolina in 2006 and later resettled in Chapel Hill. Ree Ree first joined the TTCF community in 2013 as a youth intern with the TTCF youth program. After graduating from Chapel Hill High School she became the Youth Program Coordinator, coordinating food justice activities for refugee youth participants.  Ree Ree continued to work with TTCF while in college as a cultural consultant and interpreter, and she graduated from Guilford College in Greensboro, NC as Bonner Scholar with a degree in Community and Justice Studies and Forced Migration and Resettlement Studies. In the winter of 2021, Ree Ree joined the TTCF team as the Business Development Coordinator, supporting farmers to find innovative strategies to reach long term business and income goals. 

Much attention has been paid recently in both scientific circles and in the media to a drug for weight loss newly approved by the FDA. A flurry of articles in the media hailed this drug as a breakthrough. This was prompted by the publication of a landmark article in the New England Journal of Medicine addressing the impact of this medication in a large clinical trial. Today's guest is one of the authors of that paper. Another flurry of media attention occurred as the drug became available, with news that supply couldn't keep up with demand. Dr. Thomas Wadden is the Albert J. Stunkard Professor and former Director of the Center for Weight and Eating Disorders at the University of Pennsylvania School of Medicine. He is one of the most highly regarded experts on treatments for obesity, having done some of the most important research on very low-calorie diets, a variety of medications, bariatric surgery, intervention in primary care settings, and more. Interview Summary   You and I grew up together in this profession, having spent some early years together working on treatments for obesity. You're one of the people in the field I admire most, both for the quality of your work and the breadth of your knowledge across various treatments for obesity. So let me begin by asking something regarding our former mentor, Albert Stunkard. So one of the most famous quotes of all time in our field came from Mickey Stunkard in 1959, no less, way before the field was really paying attention to obesity. He wrote that "most obese persons will not stay in treatment. Most will not lose weight. And of those who do lose weight most will regain it." There was a stark honesty to this, and it motivated Stunkard to help overweight people. So if we fast forward to today, do you think this is essentially still true?   Well, first, let me say that Dr. Stunkard's statement sounds somewhat critical. Today, we might say stigmatizing people with obesity. You know, they won't stay in treatment, they won't lose weight, they'll regain it. And Stunkard, as you know perhaps better than anybody, was an extremely compassionate, empathic person. To clarify that, he knew that the limitations to success were with the treatments available and not with the people who had obesity. So to answer your question, the first two parts of Stunkard's statement that people won't stay in treatment and people won't lose weight were probably no longer true by the early to mid-1980s. And pioneers like yourself showed that if you gave people a structured program of diet and physical activity, and most importantly, if you gave them behavioral strategies to improve their treatment adherence, then 80% of people would stay in treatment for 16 to 26 weeks. They'd lose an average of 6% to 10% of their weight. So what remained, however, and remains today, was that people have trouble maintaining the weight loss. And that's something that still challenges us.   Well, it's nice to start on that optimistic note with the hope that people will go into treatment. Let's talk about the drug. So what is the new drug, and how does it work?   Well, the new drug is called semaglutide. It comes in a dose of 2.4 milligrams and is injected subcutaneously once per week. The drug at the retail level is known as Wegovy. Some people will know about semaglutide for the management of type 2 diabetes. It is used at a dose of 1.0 milligrams and it's called Ozempic. So Ozempic was approved first many years ago. Now, semaglutide is a glucagon-like peptide 1 receptor agonist, and that's a mouthful. But glucagon-like peptide 1, GLP-1 for short, is a naturally occurring hormone that is released by the body when food, particularly carbohydrates, hits the stomach. GPL-1 is released by cells in the small intestine, and it does several important things. First, it signals the pancreas to release insulin to pick up the glucose that's coming in. And then it also slows gastric emptying, which as you know, leads to greater feelings of fullness. And then finally, these GLP-1 receptor agonists are hitting a part of the hypothalamus that stimulates fullness or what's known as satiation receptors, so people feel full earlier when they're eating and don't eat as much food. I think you may remember, Kelly, that naturally occurring GLP-1 has a very short life when it's released. It's active for about two to three minutes, so you have a temporary feeling of fullness. But these new drugs, semaglutide 2.4 milligrams, have a seven-day half-life. So people are feeling greater fullness and less hunger sort of around the clock, and as a result, they are just eating less. And to use your terms, they are less responsive to all the cues in the toxic food environment that are saying come on, it's time to eat more. It's time to have a large serving of ice cream or sugar-sweetened beverages, whatever it is. People don't seem to be as vulnerable to the toxic food environment.   I really appreciate that you've taken a pretty complex subject, namely the physiology of this drug, and made it come alive in terms that most of us can understand. So thanks for that. So before you talk about the weight losses that the drug produces, you mentioned that some treatments are producing weight loss of 5-6% of body weight. Can you place that in context for us? I mean, is that enough to produce medical benefits? Are the people losing weight happy with that degree of weight loss?   Sure, most individuals who go through a behavioral treatment program will lose about 7% to 8% of their weight on average. And those weight losses are associated with significant improvements in health. The landmark study in this area is the Diabetes Prevention Program published in 2002. People with pre-diabetes lost seven kilograms, about 7% of their weight, and they exercised 150 minutes per week. And those individuals with pre-diabetes reduced their risk of developing diabetes over 2.8 years by 58% compared to the control group. So that's a really important finding that modest weight loss, and modest physical activity prevents the development of type 2 diabetes. And weight loss is also going to improve blood pressure, and it can improve sleep apnea, so modest weight losses have benefits. But two things. First, larger weight losses have greater improvements in health. That's important to know. It's in a linear relationship there. The more you lose usually, the better the health improvements. And two, most people seeking to lose weight want to lose about 20% of their body weight. So if you're a 200-pound female, a 250-pound male, you want to lose 40 to 50 pounds, respectively. And so, larger weight losses are highly desired.   So how do you deal with that psychologically when somebody's goal is far beyond what treatment typically produces? Can people come around to the fact that the smaller weight losses are really good for me, and I've accomplished a lot even though I may not get to my goal?   Well, I always tell people, I know you want to lose 40 pounds. So let's start with the first 15 to 20. Let's focus on that because you have to go through 15 to 20 to get to 40, and let's see how you feel after you've lost the initial weight. And I can't promise you you're going to get to 40 pounds for potential genetic or biological reasons, but let's try to achieve what we can achieve and focus on larger weight loss. And many people are more satisfied than they'd imagined with a more modest or moderate weight loss, even though the dream is to lose more than that.   Okay, so back to the drug then. This big clinical trial you were involved with, published in the New England Journal of Medicine, can you quickly explain the trial and tell us what you found?   There were four big clinical trials of this medication that were presented to FDA for approval, but the seminal paper published in New England Journal treated about 1,961 participants. And everybody got lifestyle modification every month with a dietician for 15 to 20-minute visits. And then on top of that, half the participants got assigned semaglutide 2.4 milligrams, and the other half got a placebo. And they were followed for 16 months. And the reason it's a 16-month trial is that you have to introduce the drug slowly over four months to control gastrointestinal side effects. So as you start to take this drug, you're likely to experience a little bit of nausea. About 45% to 50% of people do so. So some patients, about 20%, will experience vomiting. Constipation and diarrhea also occur in response to the drug. So if you slowly introduce the drug, you can prevent some of those symptoms. And so it's not till four months that you're on the full dose of the drug, and that's why they run the trial for 16 months, so people have been on the drug for one year. And so what happens at the end of these 16 months is that the participants who get lifestyle light with placebo lose 2 1/2 percent of their weight. That's about what we'd expect. Those who get semaglutide, lose 15% of their body weight. So a remarkably robust weight loss. And when you break it down a little bit further, what happens is that 69% of the people on semaglutide are losing 10% or more of their weight. And then 50% are losing 15% or more of their weight. So that's a substantial loss. And this is something that I'd never seen in this kind of a trial. One-third have lost 20% of their body weight. And those weight losses are cumulative. So the 69% who lost 10% of their weight include the people who lost the 15% and 20% of their weight. But as you well know, those are substantial losses where the average loss is 15%, and that's achieved by 50% of the people. That is double what we get with our best behavioral treatment, and it's about double what you get with most weight loss drugs.   Yeah, that's pretty darn impressive to double the impact. I mean, most people will be excited with a a little bit of improvement. That's a lot of improvement. So certainly, we have to take note based on that. When you talked about the side effects, you were talking about the fairly immediate side effects of beginning to take the drug. And then it takes four months for people to get up to the full dose. Are there side effects that exist beyond those four months?   Well, most people will be through those gastrointestinal side effects within the four months. But, if you go out to 16 months, there will be a small percentage of people who have nausea, diarrhea, et cetera, throughout the trial. And you try to help those people with their side effects by doing things like chewing their food more thoroughly, eating smaller meals but more of them, and drinking more water. All of that can help them control their nausea if it's persistent. I think that the most serious side effect, Kelly, is that about 4% of people will develop gallstones or need to have a gallbladder removed. That is just a consequence of the large weight loss. Anytime you have large weight loss, whether it's from a very low calorie diet, from bariatric surgery, or these medications, you will find that a small percentage of people have gallstones and will need attention.   And what about the fact that people need to get this by injection? Are people able to do that okay, or is that a deterrent for people using it on a broad scale?   It's an excellent question. I can tell you that I have injected myself on several occasions just to see what it's like. You find a fat fold in the stomach and inject yourself. The needle is so small that you can't feel it. So once people try it, there's really very little hesitancy. I think certainly some people would think, "I don't want to be injecting myself with this thing," They may not even come in, but once you try it, there's no problem. And right now, there is an oral version of Ozempic. It's called Rybelsus. So it's the same medication for type 2 diabetes but in oral form rather than sub-q injection. And a trial is currently underway to see if we can make an oral version of semaglutide injectable drug, and I think that's going to prove acceptable. So that barrier should be eliminated over time.   So what happens if people stop taking the drug?   I think you know the answer. People who stop taking the medication are vulnerable to regaining their weight. And some people would say, well, that illustrates the drugs a failure because you take it and you lose weight, and you regain it, and you're no better off. But I am on a medication for high blood pressure and on a medication for high cholesterol. I can assure you that if I stop taking those medications, my cholesterol and blood pressure would go up. So this speaks to a very important issue which we have to look at obesity is probably a majority of persons as being a chronic health condition for which they're going to need long-term ongoing care and you would need to take these medications indefinitely just like I take my hypertensive or cholesterol medication indefinitely.   You know, the description of the cholesterol and blood pressure drugs is a great example. And I think this really speaks to the issue of obesity stigma, doesn't it? Because if you have these blood pressure, cholesterol drugs, and lots of others, if people are taking them and they're effective and then they stop taking them and then the medical condition comes back, it's even more evidence that a drug works. But in the case of some of these obesity drugs, people say, well, if you stop taking it and you regain the weight, it's proof the drug doesn't work. So how do you think that might be bound up with kind of general social attitudes about people with obesity?   It's such an important point. So persons with obesity are still stigmatized, as you, Rebecca Puhl, and many people have shown. And there's just so much unrelenting stigmatization of people saying, you know you should be able to control your weight by exercising more, cutting down on what you eat, push back from the table. You see, it's your problem, your shortcomings in self-control. So people with obesity are stigmatized. Similarly, obesity medications are stigmatized. Anytime I give a talk to physicians, I'll ask how many would consider prescribing an obesity medication? And only about 10% of hands go up at most. Then I'll ask, would you prescribe a drug for hypertension or cholesterol? Everybody's hand goes up, and I say, what's the difference here? And people invariably say, well, people should be able to control their eating and exercise with their willpower. And I say, well, it's an illness, it's a disease partly caused by this toxic food environment, so why are you treating that differently? You allow diabetes medications. That's caused by eating behavior to some extent. So I think you're correct. There's this profound stigmatization of people with obesity and of the medications. And I think that view is beginning to change. One of the most important things about this new medication semaglutide, and there'll be a new drug from Eli Lilly called tirzepatide, is that doctors, endocrinologists, and primary care physicians, are comfortable with these glucagon-like receptors because these are diabetes drugs that they prescribe. They're willing to prescribe that long-term. Now they may be willing to recognize obesity disease, which requires long-term treatment. They feel comfortable with the drug and that it's not going to have adverse side effects. So I hope this is a turning point in stigmatizing persons with obesity and obesity drugs.   Tom, how much does the drug cost, and is it covered by insurance? And what about people on Medicare and Medicaid?   This medication, if you go to your pharmacy and ask for it, I think is currently priced at about $1,300 per month. And so that is a very high barrier to the vast majority of people who would want to take this drug. It's possible, and I hope that the price will come down, but I haven't seen any indication of that. Some insurers and some employers cover the medication so that some people will benefit from it. But I think, as you know, Medicare and Medicaid do not cover any obesity medications at this time. There's a very important piece of legislation in the Senate and in the House called the Treat and Reduce Obesity Act, and part of that bill is to get Medicare to cover obesity medication. So even though they've got a terrific new medication, most people who would benefit from it, and particularly people of color who have higher rates of obesity, minority members, will have a very difficult time getting this drug to use it appropriately.   You mentioned that Eli Lilly may be coming out soon with a competitor drug. Do you think the competition will reduce the cost?   I would hope it would reduce the cost, but I can't say that I have any advanced knowledge of that or any assurance that that will happen. Eli Lilly has put a lot of money into producing their medication. Their medication tirzepatide looks like it will be as effective as semaglutide if not more effective by two or three percentage points. So I think probably the best bet for having a cost reduction is that another medication very similar in its mechanisms of action to semaglutide, it's called liraglutide 3.0 for obesity. It is a GLP-1 receptor agonist, it's just not as effective, it produces an 8% weight loss, it's going off patent, I believe in 2023 or '24 and when it goes off patent, I think that there will be generics to at least make that drug available at a very reasonable cost. I believe that that drug currently is at about $600 to $700 per month, but it should come down dramatically when it goes off-patent, and there are generics.   And for people who have health insurance, are insurers covering the drug?   A smattering of people are covering the drug. I don't think there's universal coverage. If you're under Blue Cross Blue Shield or whatever your company may be, remarkably, the University of Pennsylvania is covering some of these medications, which I'm delighted to see. But you would have to check your insurance plan carefully. For people who do have coverage, there are coupons to get your costs down to as little as $25 a week. So it's really worth looking into. And I know that Novo Nordisk, which manufactures semaglutide, is trying to work with insurers to get more to pick up the coverage of the drug. Let's hope that they reach some insight that'd be important to reduce the cost of this drug to make it more available to people who really need it.   Let me ask a big picture question to end our conversation. So where does this drug fit in the broad scheme of various options for treatments for obesity and how would someone or their physician know if this medication would be a good option to pursue?   Sure, if we follow just the FDA guidance and the guidance of expert panels, this drug is appropriate for people who have a body mass index of 30. So you can go, and your doctor will measure your weight, calculate your height, and tell you what your BMI is. So at a BMI of 30, you're eligible for this drug if you've tried diet and exercise, which just about everybody will have, and you haven't been successful with that alone. I think that the drug is most appropriate for people with a body mass index of 30 or greater who have significant health complications, meaning they have type 2 diabetes or hypertension, or sleep apnea. If the drug's going to be limited in availability because of it's cost, I would try to get it to the people who have the most benefit in terms of improving their health. That's the primary reason to seek weight reduction, I think. Technically, to address your question, the drug's available to people with a body mass index of 27 who have a comorbid condition such as hypertension or type 2 diabetes. And if you've got a BMI of 30, you would like to get this drug to people who have the highest BMIs and have the greatest benefit to health. Those individuals with higher BMIs at 35 who have a comorbid condition are eligible for bariatric surgery, which is the most effective obesity treatment. If you look at the most popular surgical treatment right now, it's called sleeve gastrectomy, where you remove 75% of the stomach so you can't eat as much food, and it does have improvements in appetite-related hormones such as ghrelin, the hunger hormone. That is dramatically suppressed by the operation so people are less hungry, have less desire to eat. And so that operation produces about a 25% reduction in body weight in one year. And at three to five years, people still have 20% off. So a person who's got a BMI of 35 or more with a comorbid condition such as type 2 diabetes wants to talk with his or her physician and see if they might benefit from bariatric surgery. If the doctor and patient don't think that's the option, you would like to consider an obesity medication to help you just control your feelings of appetite, hunger, and satiation, to make it easier to eat a lower calorie diet, to make it easier to want to get out there in physical activity. So that is the big picture of the options: Diet and physical activity for people who have overweight and obesity without health conditions. And then you add medications for people at a BMI of 27, 30, or greater who have health complications. And then you add bariatric surgery when medications don't work.   Bio   Thomas A. Wadden, Ph.D. is Professor of Psychology in Psychiatry at the Perelman School of Medicine at the University of Pennsylvania. He served as director of the Center for Weight and Eating Disorders from 1993 to 2017 and was appointed in 2011 (through 2021) as the inaugural Albert J. Stunkard Professor in Psychiatry. He received his A.B. in 1975 from Brown University and his doctorate in clinical psychology in 1981 from the University of North Carolina at Chapel Hill. Wadden's principal research is on the treatment of obesity by methods that have included lifestyle modification, very-low-calorie diets, physical activity, medication, and surgery. He has also investigated the metabolic and psychosocial consequences of obesity and of intentional weight loss, the latter as represented by findings from the 16-year long Look AHEAD study. He has published over 500 scientific papers and book chapters and has co-edited seven books, the most recent of which is the Handbook of Obesity Treatment (with George A. Bray). His research has been supported for more than 35 years by grants from the National Institutes of Health.  

Interview Summary   So I've been an admirer of your work for a number of years now and really perceive of you as a pioneer doing important community-rooted work. So let's start with grounding this conversation for our listeners. Would you share your thoughts on problems with the current food system?   Sure. I think there are multiple problems with the current food system. Beginning with that, we have great inequities within the food system because of the existing inequality in American society, based on economic standing and based on so-called race. And, to some extent, based on geographies - some people have great access to highly nutritious food. Others don't have so many opportunities. So, for example, in the city of Detroit, where I live, we have a few grocery stores; in fact, we actually have about 70 grocery stores. But most of those are independent smaller stores that don't offer the robust selection that we see from national stores. So the problem in Detroit is twofold: 1) that is the lack of stores, and 2) even if the store exists a few miles from you, if you don't have an automobile, you still don't have access. So these are just a couple of examples.   So we have great inequity in the food system that impacts the health of communities. The second major problem with the food system is that workers within the food system are really exploited and not paid fair wages. So we have food that is subsidized in a sense; subsidized by the exploitations of farmworkers and people working in meatpacking plants and what have you. And so, even though most people would, I suspect, think that they're paying a high price for food, the reality is we're not really paying the actual value of food. And we're externalizing some of those costs.   The third problem with the food system is the environmental degradation that it causes. The industrial food system that produces the majority of food in American society is heavily dependent upon pesticides and herbicides, dependent upon huge amounts of water, huge machinery, and the use of diesel fuels. Farms have to be huge farms for them to survive. And so there are all kinds of problems this causes for the environment, both the runoff of the pesticides and the herbicides into the water systems. And the creation of dead zones - problems created by herding cattle and pigs into small areas and trying to process the waste from that. And the system is not sustainable. We simply can't continue to feed the Earth's population using the same kinds of methods that have been used for the last 60 years or so. So those are three of the major problems with the food system. There are many others as well.   When you think about a system so embedded in the American economy and so embedded in the way we've constructed racial barriers and inequities in our country, it's hard to think that you could produce big change in this. And people, when they think big changes might automatically think about big government top-down Washington or state-driven initiatives and things like that. I'm sure there's a role for those things, and I've worked on some things, but there's also tremendous room for local ingenuity. And very often, I know, at least in the public health arena, what starts locally becomes national before long. And that's really where the innovation begins. And that's exactly what you've done. So let's shift now and talk about some of the work that you're doing. I know that you've done crowdfunding campaigns to help black farmers buy land in Detroit and advocated for urban farming, local food, and local growers, particularly during the pandemic. So what are your current efforts?   First of all, I agree with your framing that as we think about how we change the food system - looking at a top-down approach becomes very difficult. There's been a number of efforts to make a Farm Bill that is more just than equitable. But I don't know that we've seen really significant systems-wide changes due to the Farm Bill. But we can do these things on the local level that create examples of the larger change that can come about. And it can help to shift people's consciousness about how they perceive and relate to the food system.   So we've been doing some of that work in the City of Detroit via the Detroit Black Community Food Security Network for the last 15 years or so. I'll start with the effort you just mentioned - the Detroit Black Farmer Land Fund. Urban agriculture will not place rural agriculture, but it certainly can supplement it. Urban agriculture grows food closer to where we have population density centers and thus requires less burning of carbon to transport food long distances. When people eat food in closer proximity time-wise to the time it was harvested, they're going to get food that is better for them and has more nutrients. So we don't think that urban farming will replace rural farming. We believe that urban farming is a good supplement, and there are some things that we can grow in urban areas, such as Brassicas, collard greens, kale, tomato, and all kinds of things. But we're not likely to see wheat fields, and we're not likely to see herds of cattle in the city of Detroit.   We've been working with the Detroit Black Farmers Land Fund, which is really an initiative coordinated by three organizations in Detroit: our organization, the Detroit Black Community Food Security Network, Oakland Avenue Urban Farm, and a group called Keep Growing Detroit. And so, we've come together to jointly administer this fund. So far, we've given away more than $70,000 to about 40 Detroit farmers who have been trying to buy land. Just as in rural areas, obtaining land can often be very difficult for farmers, particularly in a city like Detroit, where we see a tremendous amount of gentrification. Wealthy folks are coming in, buying huge tracts of land, and driving property values up. And so farmers in Detroit often have a hard time owning the land that they're farming on or finding land even that they can purchase to farm on. So the Detroit Black Farmers Land Fund is an effort to assist Detroit's black farmers in obtaining land. This year, it's altered slightly, and grants were also given to building infrastructure. So it's one thing to have an acre of land in a city or two acres or whatever the case may be. But, still, you also need infrastructure on that land, hoop houses, fencing, water, and all kinds of things that allow you to grow food robustly. So that's one of the things that we're very excited about. The second anniversary of the Detroit Black Farmer Land Fund is coming up in June of this year. So I'm looking for that continuing to expand. Also, that effort has inspired other folks in other parts of the country. Particularly in Michigan, where we see in the neighboring county, Washtenaw County Black Farmer Land Fund, which, of course, is influenced by the work they saw happening here in Detroit.   The second thing that we do and perhaps that our organization's best known for is that we operate D-Town Farm, a seven-acre farm in a city-owned park in the city of Detroit where we grow more than 40 different fruits, vegetables, and herbs. And probably more important than the amount of food that we produce, we're planting seeds in the consciousness of Detroiters about the role that urban agriculture can play as we rethink what the city of Detroit can be and as we rethink how we improve public health. So at D-Town Farm, we do lots of tours for school groups, university groups, Boy Scouts, Girl Scouts, who are being exposed to urban agriculture often for the first time. And they're able to see the techniques that we use and can hear the ideas that drive the work we do at the farm. We do large-scale composting. Soil health is the most important factor in making sure that we have nutrient-dense food. So we do large-scale composting to regenerate the nutrients in the soil at our farm. We also have three hoop houses that we use for season extensions. We also have public events at D-Town Farm, designed to get children and families to come to the farm who might not necessarily be ready to volunteer and put their hands in the soil, but who are interested in being outdoors and learning about the possibilities of urban agriculture. So we have a number of events throughout the year, such as something in April we call the Bio Blip, where students from the University of Michigan who are studying in the School of Natural Resources come out and bring magnifying glasses, microscopes, specimen bags. They lead a group of about 100 children. They identify all the fauna, flora, and fungi at the farm. And it's wonderful, by the way, to see children from the city out at the farm, reconnecting with nature. We have a harvest festival every fall where we have close to 1,000 people who visit the farm. We have workshops, speakers, food demonstrations, tours of the farms, live music, a farmer's market, and all kinds of things that can expose the public to the great potential of urban agriculture.   We also have a youth program called the Food Warriors Youth Development Program that functions at two sites in Detroit. One site is a church, and that site functions on Saturday mornings and is open to any children in the city of Detroit between the ages of seven and 12. The second site is the school site on the east side of Detroit, and that program is only open to students who are enrolled at the school and it functions as an afterschool program. So at both sites, we have raised beds. And we teach the children how to build those raised beds, how to cultivate the food, and how to harvest the food. Then they also learn about food justice concepts. Our organization thinks that our culture is very important. And that African American people have gone through a process caused by our enslavement that has intentionally disconnected us from our traditional culture. We think it's very important that we reconnect children of African descent with traditional African cultural concepts. As well as giving them an understanding of the role that African Americans have played in the development of agriculture.   And then the third major thing that we're doing is the Detroit Food Commons, a new 31,000-square-foot building that we're building on Woodward Avenue, the main street of Detroit. It's about a $20 million project. The Detroit Food Commons will house the Detroit People's Food Co-op, a cooperatively owned grocery store, which we also initiated. Although we initiated and continue to influence it, it's an independent body with its own board. And that board regulates what will happen inside that grocery store. The first floor will be the cooperative grocery store. Still, we'll have four shared youth kitchens on the second floor of the building, about a 3,000-square-foot community meeting space, and office space for the Detroit Black Community Food Security Network. So again, we're looking forward to the opening of this in June of 2023, and we think want to be a game-changer in Detroit on several levels. One, it is a cooperatively owned business that pushes back against the gentrification that we're seeing in Detroit, where generally, very wealthy white men lead all of the development that we see happening in Detroit. And then we're supposed to see that as progress because we can walk into these edifices that wealthy white men have created and spend our money there where the community has really no ownership. And there's very little circulation of wealth within our community. The cooperative ownership of the grocery store, on the other hand, does provide for ownership by community members. We currently have 1,437 member-owners of the Detroit People's Food Co-op. That's one reason it's important, the cooperative ownership structure and how that pushes back against the typical style of development that we see happening in Detroit. It will also be a game-changer, though, because of the neighborhood that we're building in, which is called the North End. It has a tremendous lack of access to high-quality food. And so it's going to provide high quality, often locally-grown food for residents of that community and Detroiters in general. There's a vast number of people who live in the suburbs north of Detroit who work in Detroit and leave the city each day, driving down Woodward Avenue. We're also hoping that an audience will shop at the Detroit People's Food Co-op before going back to their homes in the suburbs. The third way it will be a game-changer is to provide a consistent retail outlet on a scale that was previously unavailable for local growers. And so, we are very much conscious of our role in helping to catalyze the urban agriculture movement by providing this consistent retail outlet.   Malik, that's a jaw-dropping array of things you and others in Detroit are doing, and I can't tell you how inspirational it is. Let me bring up one in particular, and it has to do with your focus on youth. Given your background as an elementary school principal, I could see why that would be a focus for you. But you could see how involving youth in this would help address the issue of getting people interested in farming and interested in other parts of the supply chain. As I imagine as the Commons comes online, youth being involved in that might give them ideas for becoming food-related entrepreneurs. The space that you have upstairs could be used for youth to develop ideas and for new businesses and things like that. I could imagine inspiring a whole new generation of people to think about these food-related activities as a viable career path, and I'm just wondering, have you seen signs of that so far?   Since we started 15 years ago, we've seen a tremendous interest on the part of young people in being involved in the food system. We have something in Detroit, for example, called the Detroit Food Academy, which is a nonprofit that trains people for jobs within the food system. They learn a wide array of fields and areas within the food system where there are employment possibilities. We have a number of farms in Detroit that are encouraging children to anticipate those farms. We have some children, in fact, who have created value-added products that they're selling at various fairs and the farmers' markets throughout the city of Detroit. So yeah, we do see an increasing interest. Part of what we're setting out to do is first to help people think about the food system because the average person, people who aren't food activists, don't even use that term, the food system. That's not how they think about food. They're thinking about, "I'm going to the grocery store to buy what I want. I'm going to cook dinner, and I hope I like the way it tastes," and that's the kind of framing the average person has about food. So part of what we're trying to do with both children and adults is getting them to think about this broader system that provides food and all of the kind of steps in it from the seeds to the planting of those seeds, the cultivation of the crops, the processing of crops, the aggregation of crops, the distribution, the retail level, the post-consumer level. We want people to think about all of that and then think about how they begin to develop agency within it so that they don't just see themselves as subjects that this more powerful system is acting upon, but they see themselves as having the agency to actually shape that food system as it impacts their community. And so that's part of what we've been trying to do with the work of the Detroit Black Community Food Security Network, working in a number of areas both in policy and farming, in retail, trying to get people to really conceptualize what this food system is and that they have the right and the responsibility to help shape how that food system impacts them. So, yeah, we're seeing interest by youth, and we are hoping that the kitchens on the second floor will inspire not just youth entrepreneurs but also adult entrepreneurs. And there are a number of people in Detroit who participate in what we call the shadow economy, people who are making money in ways that are outside of the laws of the society. For example, you have a number of people who are preparing chicken dinners and fish dinners or perhaps soups and cakes and selling them. The kitchens on the second floor of the Detroit Food Commons allow those entrepreneurs to go from being underground shadow economy food entrepreneurs to actually coming into the legitimate legal economy by having a licensed kitchen where they can prepare their foods. So we are definitely looking to stimulate the local food economy both for children and adults.   Let's talk a bit more about that. So in some of your beginning comments, you mentioned low wages as one of the fundamental problems in the food system. Are you hopeful that this series of activities will provide better pay opportunities for people?   I'm hopeful, but I also want to acknowledge that it's a very difficult problem. And even as we look at the Detroit People Food Co-op and how to make that cash flow positively, as we look at the performance and all of the expenses, the wages that we're scheduling to pay employees are certainly not what we would like to pay. And so we're strategizing on how with very thin margins in the grocery industry, we can be fairer and just to the workers who will work in that store, but this is not a unique problem that we have. In fact, I would say that the major dilemma facing the food movement in American society is figuring out how we pay workers within the food system a fair and just wage while, at the same time, we make sure that we have food that is available and affordable to everyone in society, regardless of their race, income, or geography. It's a very difficult nut to crack, and I'm not absolutely positive that it can be done within the current economic system, but it's certainly something that we have to strive for and that we have to strategize on. I don't think there's an easy answer to that, but it's the question that we have to constantly put in front of us. For me, the obvious answer, though, is that we have to marry the struggle for food justice with the struggle to eliminate poverty. The answer to this problem is not cheap food per se. The answer to the problem is paying the true value of food but making sure that everyone has the income which is necessary to buy high-quality food.   Let me ask about the importance of community ownership of these things. So let's just say hypothetically that all the activities that you're talking out were being put in place from Washington or the state of Michigan, let's say, as opposed to a very community-involved effort. What's the symbolism of that, and what difference do you think it makes in the way people think about these things?   Well, I think it makes a huge difference, and again, part of what we're trying to instill in people is a sense of agency. I think it's true to say that in American society in general and in Detroit in particular, people have been locked into a lethargy where they think that people who are more powerful are in charge of structuring their lives, that the educational system is responsible for teaching our children, for example, and that doctors are responsible for maintaining our health. And in many ways, we've ceded responsibility for our own lives to these forces that we perceive as being more powerful and particularly in a place like Detroit, where, over the last 20 years or so, we've had the imposition of what the state of Michigan calls emergency managers. The largest or most well-known in the position of the emergency manager was in Detroit just before the city declared bankruptcy. The governor essentially suspended the powers of all of the elected officials and appointed one individual who was the emergency manager of Detroit. These powers superseded all the powers of the elected officials, so essentially, democracy was put into a coma in the city of Detroit. So I'm saying that in a situation that both intentionally disempowers people and also where people cede responsibility because they perceive these more powerful forces as being more qualified to run the systems that impact our lives, people have given up; in many cases, their agency over defining not just the food system that impacts their lives but defining all of the systems that impact their life. And so we're very concerned about developing a sense of community self-determination that every community first decides what their own goals and aspirations are and then decides how they reach that as opposed to external forces coming in and dictating to communities how they should move and develop, and so that's really at the core of what we're doing. So having these community-based projects that mobilize community members and ignite within them this sense of agency both within the food system, and then we're hoping that also as people see that we can exert control over the food system, they begin to look at other aspects of their lives as well and how we can, as a community, begin to exert control over those things. So having said all that, that's not to say that state and federal governments don't have the responsibility of behaving in a way that facilitates justice, equity, and access to high-quality food for all of their citizens. Still, I certainly don't think that we should put the majority of our efforts into that and that we shouldn't wait until those governmental entities act to make things better. We have the right and the responsibility to act on our own behalf while, at the same time, pressuring and urging the government to act in a responsible way.   That makes perfect sense. And I'd imagine another virtue of the community ownership part of this is that the initial innovation breeds more innovation because more and more people think that they can have the agency that you're talking about, come up with new and creative ideas. So I could imagine this building on itself over the years.   Yes, absolutely. I think that mobilizing people to solve their own problems certainly stems from innovation. The challenge is that often, very creative, innovative people in communities like the community I live in don't have the resources to implement those innovations. So we have to always look at that side of the equation also. How do we better resource communities so that the people who have the lived experience and who are most impacted, and who have this tremendous creativity, have the resources that are necessary to bring these ideas to scale, so they have a larger impact?   Bio: Malik Yakini has been involved in the Black liberation movement throughout his adult life. His resume includes more than 20 years as principal of a K-8 African-centered school in Detroit along with founding the Detroit Black Community Food Security Network, which works to build self-reliance, food security, and justice in Detroit's Black community. His connection to food work began about 20 years ago, when he began gardening on a small plot of land at his Detroit home to ensure he had access to fresh food. With few full-scale grocery stores in urban neighborhoods and just one national chain located in Detroit, Yakini saw the need to expand this work to community gardens and to teach young people to get their hands dirty. In 1999, he developed a food security curriculum as principal of Nsoroma Institute, an African-centered school that operated in Detroit from 1989 to 2014.  

In today's podcast, we're talking about ultra-processed foods. Our guest today is Trish Cotter from the global public health organization Vital Strategies. She's the author of a new commentary published in the BMJ Global Health calling for warning labels on ultra-processed foods. Interview Summary   First I'd like you to tell us, what our ultra-processed foods? And how do you think they're affecting health?   So as you mentioned in the introduction, I lead the food policy work for Vital Strategies. Our team supports partners and governments to introduce high-impact policies aimed at creating a healthier food environment. Now, these policies that we focus on are taxes on sugary drinks and junk food, restrictions on marketing of unhealthy food, especially to kids, and front of package labels on foods that are high in fat, salt, and sugar. The common denominator amongst all these policies is ultra-processed foods. So your question, what are ultra-processed foods? They're foods that you can't make at home in your home kitchen. In fact, as you said, this debate about whether they're even foods at all, and you'll find them on the supermarket shelf, packed full of them, soft drinks, breakfast cereals, ice creams, frozen prepared dishes. They're products that go through many manufacturing steps which alter the food from its natural state, and they're quite literally torn apart and put back together again with the addition of a cocktail of preservatives and flavors and colors. And what we get at the end of it are products that are packaged, ready to eat, hyper palatable. Some research is indicating that they're addictive and ultimately leading to long-lasting consequences on a person's health.   So you're completely in agreement there with some of our other guests who have spoken about ultra-processed foods and noting the dangers of them. Why do you think the public has remained unaware of the risk of these foods?   One of the reasons is that the term itself is relatively new. It's coined by Brazilian professor Carlos Monteiro in about 2009, and while the research community's quite familiar with it and have been researching it over this period of time and increasingly so, there's been limited data about the public's understanding of ultra-processed products. So part of the Bloomberg Philanthropies Food Policy Program, Vital Strategies supported some studies in Brazil and Colombia in 2017 and '18, which included several questions on public perceptions of ultra-processed foods or products. And what we found was clear evidence of the food and beverage industry's success, really, at marketing these products where we saw a significant number of people associate them with satisfying cravings, being tasty, bringing happiness and joy, and you can all understand what those products are. Also, they associate them with family, social gatherings, children, ease, and even breakfast and physical activity. So the evidence also was really enlightening in that we found was that, while people aren't really familiar with the term, they recognize the group of products as harmful. So it makes sense to them that this scary sounding word, ultra-processed products, could be harmful.   What are your thoughts on the food industry involvement in food environments and food policies?   So look - unhealthy products, unhealthy diets are responsible for an estimated 11 million preventable deaths each year, and with this at the forefront of our minds, we cannot forget that food and beverage companies' first responsibility is to their shareholders, not our health. So let's have no illusions about why they may seek to be involved in food policy. The industry also has a vested interest in maintaining the status quo of continuing to freely promote thousands of individual products that they have us believe are tasty and convenient, but in fact, as we've described, they're full of nasties and harmful to our health. So while there are thousands of individual harmful products, they cannot be really targeted by public health policy. But the minute they become known as one, for example, ultra-processed foods or a collection of foods that are high in fat, salt, and sugar, governments will find ways to regulate them, and that's when we'll see large corporations flex their muscles. Letting the industry engage in policy solutions usually leads to ineffective or weakened policy at best. They're part of the problem, and while they need to be part of implementing the solutions, they cannot be part of the policy making. Health policy is for health experts. That process can't be muddied by commercial interests.   You've just answered this question, but it's an interesting one to talk a little further about. When an industry feels under threat from litigation or regulation, legislation, one thing they typically do is say, "You don't need the police us. We'll police ourselves, and we'll come up with these self-regulatory efforts, and we'll abide by this, or we'll create that standard." They do a lot of that kind of thing. It doesn't sound like you're optimistic.   Absolutely, and in fact, I'm less than optimistic. I'm convinced, and we've seen lots of examples worldwide, that voluntary agreements don't work. And of course that's what the industry will propose because that's what they can live with, and that's how they will continue to go on the path of least resistance. But it's incumbent on governments and public health practitioners to respond decisively and to implement strong mandatory policies so that we can advance the public's right to healthy and nutritious food because the fact that over 50% of the calories that they're consumed in US, for instance, ultra-processed means that these companies have just gone ahead and managed to take over our food environment without any opposition, and it's time they were held to account.   I agree with you entirely. All you have to do is read about how other industries have responded under these circumstances to know what the food industry was likely to do. And yet we still let them do it. For example, marketing foods to children - they created a self-regulatory effort that then the field has to spend a lot of time proving doesn't work. But now those things have been proven, and so the time to expect industry to change on its own seems to have long passed. So I agree with you that coming up with better regulations makes perfect sense. Let me ask you about obesity rates during COVID. Then I'd like to come back and ask about ultra-processed foods in particular. So the rates have risen in some parts of the world during COVID, obesity rates, that is, including the United States. What's your take on this?   I think that COVID-19 really exposed the vulnerabilities in our food system. And what it did was accelerate an already alarming trend in our global weight status, I guess, is the way to describe it. But also what happened is that, throughout the pandemic, many people were faced with food insecurity for the first time in their lives, and almost all of us have seen shifts in availability and supply. So when there's no food available, hardly any food available, any food is better than no food, and one of the things that the industry did so well during the pandemic is capitalize on it. They used that opportunity to really lift their corporate social responsibility profile. One of the things we must do is not blame the individual who often have very little control over their food environment. We think we're making our own decisions when we are purchasing food, but really, someone else is pulling the strings. Many times, a large food or beverage company has made that decision for us before we even get to the supermarket by setting prices, designing products that are easy and convenient and that look good, look tasty and nutritious, but in reality, they're something quite different. And even before the pandemic, worldwide palates and brains have been trained to crave these unhealthy foods, and we know that the industry has invested millions upon millions in formulating and marketing them to be highly desirable. So the person who's the consumer is very much like a puppet.   It's an interesting way of thinking about it and deadly combination of vulnerable biology, industry exploiting that biology, and the heavy marketing of foods makes for a pretty powerful picture. So what are some of the possible solutions? What do you think that public health community and policy makers and advocates and others can do to raise awareness?   Well, I think we really have a responsibility to warn consumers about the harms of ultra-processed foods. At the moment, they're in the dark. So what could we do really is the question. What could we do to warn them? The first thing in our favor is that the term ultra-processed food, as I said earlier, is really unfriendly, and people can conceive that these products as being unhealthy, and most recognize them in our research as being harmful. So we can use this to our advantage to fight against industry marketing efforts. Just like the marketing industry builds a brand around a product, the public health community needs to build meaning around this term ultra-processed to alert consumers about its harms. We can also look at past movements like tobacco control and see where the public health community has achieved huge policy wins in strong public understanding of the consequences of consuming a dangerous product. Raising awareness is incredibly important. We've spent over 50 years educating the public on the harms of tobacco. We're going to need to do that for this category of products. We can also add information about the level of processing to food packages and warn about the products that are ultra-processed. Evidence shown that and our own consumers to make healthy decisions through clear front of package labeling really has a positive effect. We know that most shoppers spend 10 seconds or less selecting each food and beverage item. They need quick and easy ways to select the healthiest foods to avoid unhealthy foods. A number of countries, particularly Chile, Mexico, have introduced front of package warning labels in an effort to address poor diets. If in these examples we could further strengthen the warning labels by adding the descriptor, "This food is ultra-processed," we would be further educating the community about which foods are safe to consume and which aren't.   That raises a very interesting point that I know these warning label systems that you're talking about tend to score foods according to being high or low in particular nutrients. So foods high in sugar, for example, would get a poor score. And I think the point that you're making, that's very well taken and others have made as well, is that there's something about these ultra-processed foods that is damaging beyond the fact that they carry lots of bad nutrients with them. It's the processing itself that is part of the reason our human biology is being thrown off. So if that's the case, then labeling these would be very interesting. It might be pretty simple to take these existing labeling systems and just add an additional criteria for giving a food a poor score. It sounds like you're optimistic that this could occur given that it's occurring in some countries already.   Yes, I do agree with that. The opportunity here is that when industry reformulate their product as they do in some countries if they're able to reduce the levels of fat, salt, and sugar in their products to avoid with the label, it doesn't stop the product from being ultra-processed. So what we are trying to avoid is the situation where we see no labels on ultra-processed products, so no warning labels for fat, salt, and sugar, but the product remains ultra-processed and, therefore, it's still harmful. So this is one proposal that might help mitigate that. It might help the public continue to understand that it's not just the fact of these single nutrients that are harmful, but it's the whole product that can be dangerous to people's health.   Bio:     Trish Cotter is the global lead for the Food Policy Program at Vital Strategies. She has extensive experience aligning strategic communications to achieve policy and behavior change outcomes across several areas of public health including food policy, tobacco control and cancer prevention and screening. Trish is the lead author of a new commentary published in BMJ Global Health: ‘Warning: ultra-processed' — A call for warnings on foods that aren't really foods. She holds a master's degree in public health from Monash University in Melbourne, Australia  

We're speaking today with Mia Hubbard, vice president of programs at MAZON, a Jewish response to hunger, which is a national advocacy organization working to end hunger among people of all phase and backgrounds in the United States and in Israel. This is the fifth and final episode in our series partnership with MAZON. This time we will focus on the organization's work to increase access to nutritious foods in the charitable food network. Interview Summary   Now let me start off with this question so I understand that MAZON has for quite a long time provided partnership grants to state and local organizations fighting hunger in their communities, but in 2018 MAZON refocused this grant making in states specifically with the highest rates of food insecurity. Can you please speak about this pivot that the organization made? How was it decided? And what's been the impact of this decision?   So our grant making for the first 25 years or so really focused on advocacy and on the need for strong government response to hunger with this understanding that charity has an important role to play, but it is not set up to address this issue. And it's really government food programs that have the capacity and the reach and the ability to address this issue at the scale that's needed. So in our early years, we focused on prompting the anti-hunger field to understand the need for advocacy and policy change directed at improving government programs. And we did that through our early years of grant making. So we're known for funding anti-hunger advocacy organizations, helping them to seed and grow and supporting their work. And helping to establish this country's network of state level anti-hunger organizations that were doing advocacy at both the state and national level.   And then in 2018, we really decided we wanted to take a step back and re-examine our grant making and see if there were some new opportunities for MAZON to uniquely contribute to the field. And by that time the nation had a very strong anti-hunger advocacy infrastructure in place. And a really solid group of organizations working at the national level on developing drawn government food policies and programs. And a broad network of state-based organizations doing the same at the state level. So one of the things that became clear is that there still were some states that had relatively weak advocacy capacity. There wasn't as much advocacy engagement taking place in those states and not surprisingly, these were also some of the most food insecure states. We decided at the time we would target our grant making to just a handful of the top food insecure states where advocacy capacity could be grown and created what we the Emerging Advocacy Fund, which is providing three-year funding to organizations in these food insecure states to create the capacity. And really what it means is to hire staff, to be able to do the advocacy work that needs to be done in those states. And we call it the EAF program. So our EAF partnerships are largely concentrated in the Southeast, and we have some partners in the Midwest and some other parts of the country. But primarily in the Southeast and you know it turns out that these are states that tend to be deeply conservative. They tend to be states that are politically and socially hostile, in some instances, to public benefit programs like SNAP, formerly known as the food stamp program. So unfortunately these are also the same states that are likely to benefit the most from these programs. Participation among those who are SNAP eligible in these states tend to lag behind the national average. So folks aren't getting the resources they need to be able to feed themselves, and the state is leaving precious hunger fighting resources in DC, rather than having that money being circulated in their local economy, as people are using their SNAP dollars to buy food. The goal of the EAF program is really to help close that capacity gap and to enable organizations to hire staff who can do the advocacy to really make the case for these programs and supports.   I think we saw in the last 18 months, the economic fallout from COVID generated a really large surge in hunger. These organizations and these advocates, were in a great position to be able to educate their congressional representatives about how COVID was impacting food insecurity in their state. They were able to contribute to national advocacy that helped generate all of the support and funding that came out of federal relief packages, and then to work with their governors and state officials to encourage them to take advantage of all the federal waivers and flexibilities, and options that states had available to them during those early months of COVID to get resources quickly into the hands of food insecure people. And so we didn't predict that COVID was going to happen, but these grants turned out to be timely investments and enabled advocates in states that were already struggling with high levels of food insecurity be able to better respond to the needs during COVID.   Mia can we talk about one of MAZON's priority areas in particular - your concentration on strengthening food security and also food sovereignty in Indian country. So why have you chosen to invest so much in this issue and where and how do you think your organization can have the greatest impact?   You know MAZON is known for our focus on advocating for equal access to food for populations that have been historically ignored in policy arena. So we advocate on a lot of different populations including active duty military, single mothers, Americans in Puerto Rico, and also in indigenous communities. Our work in Indian country is focused on food sovereignty in recognition of the fact that tribes are sovereign nations and our work should be contributing to the ability of those nations to regain autonomy over their food systems and for tribes to be able to feed their own citizens. So we have learned very quickly in our work in Indian country that US food programs, government food programs are an important part of the food safety net. But we also know that the US has a long and troubled history in Indian country and that government food programs have been used as a tool of colonization. So we are working to advocate for improvements in these programs, but we're also working for a day when they are less needed. And where tribes can have greater control over these programs and how they operate, that's why MAZON joined the native farm bill coalition back in 2017 to be able to advocate and join over 170 tribes, to be able to advocate on behalf of tribal nations that were interested in being able to administer these programs on their own. We were the first actually non-native organization to be a part of the coalition. We're very excited about our role is as a non-native ally in this field, we weren't able to get that provision in the farm bill, but there were some other successes and in fact, there were 63 tribal specific provisions in the bill, which is the largest number in the history of the farm bill.   So we're very excited about the work that we're doing alongside our partners in Indian country. If you'll indulge me I just want to mention their names. It's the indigenous food and agriculture initiative, Intertribal Agriculture Council and the Native Food and Nutrition Resource Alliance. We are doing advocacy alongside these partners and we're also funding them, really in recognition of the fact that government and foundation funding really isn't going to native communities and causes. Less than half of 1% of foundation dollars go to Indian country. So we're really excited to be able to support their ongoing advocacy and policy work.   That's really is important work. So let's talk about other important work that you're doing. And I know that MAZON recently announced new partnership grants in Puerto Rico signaling that the organization is interested in addressing equity for those facing hunger in the territories. So why was this an important decision, particularly at this time? And what do you hope to achieve through this?   So Puerto Rico is a very exciting addition to our emerging advocacy fund. And we're currently supporting three partners there on the island. These grants are part of MAZON larger advocacy effort around food security in Puerto Rico. It's one of our top public policy areas and priorities where we're really trying to advocate for equal access to federal food programs for Puerto Rico. So as you may know Puerto Ricans are US citizens, but they don't have the same kind of access to federal programs that are intended to help vulnerable Americans and in the case of Puerto Rico, they are specifically barred from the SNAP program. I mean in the 1980s, the Reagan administration removed Puerto Rico from the SNAP program and created a separate program called the Nutrition Assistance Program (NAP), which is a block granted limited funded program, which provides food assistance to the island in lieu of SNAP. But because it is block granted and has limited funding, most SNAP participants receive much lower benefits than they would if they were participating in SNAP. And so this is an area where we are particularly concerned about the inequity that's built right into the structure of the program. And even before COVID over half of Puerto Rican children lived in poverty about one third of adults were food insecure.   We know the island has been struck with multiple natural disasters, hurricanes earthquakes. It has a very fragile economic situation. And so there's a lot of work to be done in Puerto Rico on a number of issues. We're very excited to be working with our three partners on the ground to support advocacy for and by Puerto Rican people. Think it's very important for mainland advocates like MAZON to be allies, but we really want to make sure that federal food programs and policies are shaped by the needs and experiences of Puerto Rican's. Similar to the work in Indian country. There's this colonial kind of relationship that we have with Puerto Rico. And I think it's created a false narrative that Puerto Rican people are passive beneficiaries of aid right that they are reliant on US federal support. And I guess the reality that we're seeing in the work that we're doing with our partners is that Puerto Rican advocates and leaders have their own vision for how they want to achieve food security for their island. And so we're just really proud to be able to invest in their capacity and their ability to determine their own future around food security.   The investment in these populations in need is very impressive. And you find an area where you could really make a difference. Let me ask you one final question about one time quick reaction fund grants that MAZON and gives for rapid response initiatives, things that might just come up on the spur of the moment. So why is this an important tactic in addressing hunger in the way the world now addresses hunger and why is being nimble so important? Can you give us an example or two of this?   Our quick reaction fund, we call it our QRF fund, is something that's really, I think new for the anti-hunger advocacy field. You know, you see these kinds of rapid response funds exist in other areas whether it's you know racial justice or immigrant rights, we were excited to bring this expedited access to financial resources, to the fight against hunger. And I think it's an important tool in the toolbox for MAZON and for the field because even though government food programs have historically had bi-partisan support, we've seen in the last 10, 15, 20 years that they have come under increasing attack and being able to respond strategically to that requires the ability of advocates to be able to move quickly and nimbly, particularly in their state capitals. So whether it's doing an ad buy in a key media market to influence the vote of a lawmaker in a given state or organizing a campaign quickly to get a group of folks with lived experience up to the Capitol for a hearing or for a day of action, those are the kinds of things that the quick reaction fund is intended to be able to enable our partners in the field to do. Last March right before COVID hit the Kentucky state legislature for example, was quickly moving on a bill that would have put lifetime bans on some public assistance programs in the state including SNAP. And we were approached by our partners in the Kentucky equal justice center to do a quick response to this piece of legislation that was moving pretty rapidly through their legislature. And they mounted a digital campaign aimed at the lawmakers who were sponsoring this bill. They raised a lot of visibility about the bill and about the harm that it would cause for folks who were struggling with hunger and poverty, and they were successful in being able to strike down this law. And it was a very timely victory of course, because a month later COVID hit and a lot of Kentuckyians turned to these very programs to get through those early months of COVID and the surge in hunger that we saw.   Bio   Mia Hubbard is the vice president of programs at MAZON. She provides leadership and direction for MAZON's advocacy, grantmaking, and strategic program efforts to reduce and eliminate hunger and expand low-income communities' access to healthy food in the United States and Israel. Since Mia joined the organization in 1993, MAZON has established itself as a leading advocate, funder, and capacity builder in the field of hunger as well as a critical source of expertise, leadership, and inspiration for advocacy and public policy solutions to hunger. Mia has served on several boards of directors, including most recently as the international program committee chair for an international association of food and nutrition programs serving people living with HIV/AIDS. Mia holds an M.A. in International Relations and Public Policy from the Graduate School of International Relations and Pacific Studies at UC San Diego and a B.A. in International Relations from Stanford University.    

The food system does not serve everyone equally. Hunger is rooted in systems of inequity, including systemic and structural racism. Structural racism is at the root of hunger and the health disparities we see in the US today. In this episode, we'll talk to Suzanne Babb about the impacts of historical policies on the food security of communities of color. Suzanne is co-director of US programs at WhyHunger.org, New York. She is also an urban farmer and founding member of Black Urban Growers. Interview Summary   So Suzanne, could you start out by explaining to us the meaning of the term structural racism and how it impacts black indigenous in communities of color today?   - Sure. So I'm going to use a definition from Dr. Camara Jones, a public health researcher who talks about the impacts of racism on health. So she starts out by defining institutional racism, which is the systems of policies, practices, norms, and values that result in differential access to goods, services, and opportunities in society by race. So how that shows up is inherited disadvantage, in this case, Black, Indigenous, and people of color, and inherited advantage, and in this case, in the US it is white people who have that advantage. And the way that this gets manifested is in terms of material conditions and access to power. So we're looking at access to housing, education, employment opportunities, income inequality, different access to medical facilities, access to a clean environment, access to power through information, resources, and voice like in the media. So laying that out when we're talking about structural racism, structural racism is about how these policies and institutions act together to lead and produce barriers to opportunity and lead to racial disparity. So for example, we could take the mass incarceration of Black men and women. That is a relationship between the education system, the whole quote to prison pipeline between the criminal justice system and between the media that often perpetuates the myths about black people and criminality.   Thank you so much for laying that out for us so clearly. It's important to remember for us that the structures we have today are the result of our multitude of historical insults. What are some key historical flash points to keep in mind when we think about the relationship between hunger and the right to food?   I think there are two big ones that I can give in as an example as historical insults. The first one would be the dispossession and murder of Indigenous people in populations of their natural resources beginning in the 15th century. And then also the transatlantic slave trade where millions of West Africans were kidnapped, enslaved and shipped across the Atlantic Ocean, sold as chattel to do backbreaking labor from the middle of the 15th century to the end of the 19th century. And this is important because this is the beginning of where oppression and structural racism began for these groups of people, and that policies and practices have just been created and evolved to continue that oppression.   So over the last century there've been a number of policies or specific political acts that have shaped the US food system and negatively impacted the right to food for communities of color. I wonder if you can identify for us some of those key political actions.   Yes, so I'll identify three areas: the Social Security Act of 1935, several USDA farm policies with impact particularly on BIPOC farmers, and urban planning and neighborhoods; and the National Housing Act of 1934.   Let's now take each one of those policies one at a time, beginning with maybe the Social Security Act. Tell us a little bit about how that Social Security Act affected the food security of communities of color?   So the Social Security Act was created to protect Americans by providing folks in their old age, survivors and folks who have been disabled insurance; so payment in those times when they're no longer able to work. But what happened was during that time, it excluded domestic and agricultural workers. And 60% of the Black labor force were domestic and agricultural workers. That was completely intentional. Then domestic workers were included in 1950 and agricultural workers were included in 1954. But that left out a generation of people who couldn't accumulate family wealth or couldn't get their basic needs met during that time when they could no longer work because of age or disability. And so if they had hunger or food insecurity already because they probably weren't earning enough money, that was further perpetuated by not being able to access social security.   So the Social Security Act created into generational sort of oppression, increasing the combined food insecurity for communities of color. Now, I wonder how the USDA farm policies also operated as structures of racism?   If we look at the way in which the USDA gives out subsidies, for many decades, they have given out billions of federal subsidies to companies and large scale farms that produce corn syrup, high fructose corn syrup, corn starch, and soy. And we may know now that a lot of those products end up in food, and they help to perpetuate chronic health diseases. And so these processed foods end up in neighborhoods of color and poor neighborhoods at a higher proportion than white wealthy neighborhoods. So not only are we impacting farmers, we're impacting the health of the communities in which receive the end product of this. Now most farmers of color usually farm what's called specialty crops, which is fruits and vegetables and livestock. These types of crops are not eligible for the commodity programs and receive way less government support. And even when you look at the support that they do get, there is some racial discrimination there. So for example, the Haas Institute said that white farmers that grow specialty crops receive a payment of about $10,000 per farm, while Black farmers receive an average of about $5,000 per farm.   So not only are communities of color restricted in buying food, but also heavily restricted in growing their own food through these political actions. Now, when it comes to urban planning, can you talk to us a little bit about the impact that urban planning policies have on neighborhoods and communities?   So I'll talk about the National Housing Act 1934, which was implemented by the Federal Housing Administration. And the purpose of this was to promote home ownership and launch many Americans into the middle class. The FHA provided loans to people so that they could purchase houses, but many people of color were largely left out. In fact, about 2% of these FHA loans were made to nonwhite buyers. What the FHA did was they gave certain neighborhoods different credit ratings. And often what they would do is if you were a suburban or a white neighborhood, you got a higher credit rating than a more ethnically diverse or economically unstable neighborhood, which tended to get lower credit ratings; which made them seem more risky and they had less chance of getting loans. Now we know home ownership is how people get launched into middle class and are able to accumulate generational wealth. So the inability to do this left people of color without that ability to accumulate generational wealth. And this policy also has four major ways in that it impacted people's lives. So because a lot of the folks who received the loans were then moving into the suburbs and out of the cities, many policies favored building roads and highways into these new suburbs and then drove divestment away from public transportation in cities, which people in the cities, mostly people of color needed to get to jobs and to grocery stores. The relocation of homeowners also meant that they drove out grocers and other retail operations into the suburbs, and that people lost access to employment and also lost access to good places to get food. Local farmland was also lost because of the creation of these new suburbs. So you had to go even further out for folks to be able to get access to good fresh food in the city. And then also they lost a strong property tax base, which led to a decline in public school investment, which included quality school food programs.   Thank you for laying that out so clearly for us. I think it really gives us a sense of how these structures of racism operate almost in invisible ways to reduce the power and food security of communities of color. To end with, I'd like to ask you a question about power in communities of color. What are some ways in which black indigenous and people of color are pushing back against these structures of racism?   There's so many different ways! As we said at the beginning, institutional racism and structural racism are about policies and practices. And so BIPOC communities are taking action in those same ways. So if we're looking right now at critical policies, folks are really lifting up the emergency relief for BIPOC farmers, act that came out of the American Rescue Plan, and the legislation that has been presented around justice for Black farmers. There's also been a really big movement towards connecting to land. There's the Land Back movement, which is a movement organizing to get indigenous land back in the hands of indigenous people and communities. And a lot of folks are bringing up again reparations, which is recognizing the centuries of the government and corporations profiting off of the harm that they've inflicted on black people. But if we're looking particularly at food sovereignty, some of the ways that BIPOC folks are building power is through healing that connection to the land. And a lot of that looks through buying the land and stewarding that land communally and cooperatively. It's looking at more people going back to farming, to foraging, to hunting in the ways of their ancestors and honoring those practices and knowledge. It looks like seed saving. It looks like many people growing herbal medicine and using those practices because of the differential access to health care that folks have. It looks like defending the rights of mother earth, defending the land and water and see if you've seen many defenses against pipelines by indigenous communities. And it also, I think more importantly, all of these are part of looking at different economic structures that are not exploitative or extractive. You know, really looking at solidarity economies and things like just transition.   Bio:   Suzanne Babb is Director of US Programs, Nourish Network for the Right to Food. Suzanne works in collaboration with partners to transform the emergency food system from one rooted in charity to one rooted in justice and to build solidarity between emergency food providers and food justice organizations. Through participation in local and national level strategic partnerships, Suzanne helps to create space and facilitate dialogue around the systemic inequities that cause hunger and poverty. Originally from Montreal, Quebec, Canada Suzanne has many years of experience working on community development projects within the English-speaking Black community of Montreal on issues of education, employment and health. Prior to joining WhyHunger, Suzanne was the Community Outreach Coordinator for the Get Healthy Harlem website at the Harlem Health Promotion Center. Suzanne is a member of Black Urban Growers, an organization of volunteers committed to building community support for urban and rural growers and nurturing collective Black leadership, and an urban farmer at La Finca del Sur Urban Farm, a Black and Latina women led farm, in the South Bronx. She holds a BS from Concordia University and an MPH from Columbia University.    

This is "The Leading Voices in Food" podcast but today we're speaking with a leading voice in tobacco control. "How come," you might ask, "why?" So I believe for many years that the parallels between the tobacco industry and food industry practices are nothing short of stunning, and that our field would do very well to learn lessons learned from the pioneers in the tobacco wars. Our guest today is Dr. Kenneth Warner, Distinguished Emeritus Professor and former Dean of the School of Public Health at the University of Michigan. Ken's research focuses on the economic and policy aspects of tobacco and health. Interview Summary   So Ken, you and I have a long history, and I thought it might be instructive to mention just a little bit of it because you really helped shape some of the ways I think about addressing food policy. So I first became familiar with your work long before I met you in person, when I was teaching classes at Yale. I was assigning papers you wrote on tobacco control and I was especially interested in work that you'd done on tobacco taxes. It really gave me the idea of pushing ahead with food-related taxes. Then finally I got a chance to meet you in person at a meeting that was hosted by the first President George Bush in Kennebunkport, Maine, on cancer control. You and I got to talking about similarities between the tobacco industry behavior and the way the food industry was behaving. We were both struck by the similarities. That led us to write a paper together that was published in 2009 in "The Milbank Quarterly." And I have to say, of all the papers I've published over my career, this was one of my favorites because I really enjoyed working with you. I learned a ton from it, and it really, I thought, made some very important points. And I'd just like to mention the title of that paper because it pretty much summarizes what it found. So the title was, "The Perils of Ignoring History: Big Tobacco Played Dirty and Millions Died. How Similar Is Big Food?" In my mind, the playbooks are still very similar, and that's why it's really interesting to talk to you today, get a little sense of what's happening more recently, and importantly, think about what lessons are learned from tobacco control. I wanted to bring up one thing from that paper that I always found fascinating, which was the discussion about something called "The Frank Statement to Cigarette Smokers." Could you describe what that was and what role you think it played in history?   Sure. Just to give you some context for it, the first two major papers that implicated smoking in lung cancer were published in major medical journals in 1950. In December of 1952 there was an article in the "Reader's Digest," which incidentally was the only major magazine that did not accept cigarette advertising, that was entitled, "Cancer by the Carton." And this was the American public's first real exposure to the risks associated with smoking, and it led to a two-year decline in cigarette smoking, a very sharp decline, something that was unprecedented in the history of the cigarette. Following that there was some research published on mice and cancer. And needless to say, the tobacco industry was getting pretty nervous about this. So the executives of all the major tobacco firms met in New York City in December of 1953, and they collaborated on what became a public relations strategy, which drove their behavior for many years thereafter. The first thing they did was to publish "A Frank Statement to Cigarette Smokers" in January of 1954. This "Frank Statement" was published in over 400 magazines and newspapers, and it reached an estimated audience of some 80 million Americans, which would be a very good percentage of all Americans in those years. And they talked about the fact that there was this evidence out there, but they said, "We feel it is in the public interest," this is a quote, "to call attention to the fact that eminent doctors and research scientists have publicly questioned the claimed significance of this research." Then they went on to say, and I quote again, "We accept an interest in people's health as a basic responsibility, paramount to every other consideration in our business. We believe the products we make are not injurious to health and," and this is the kicker, "we always have and always will cooperate closely with those whose task it is to safeguard the public health," end quote. They went on to say that they would support research on smoking and health, and, of course, that they would always be the good guys in this story. This was designed as part of a strategy to obfuscate, to deceive the public, basically, to lie about what they already knew about the health hazards associated with smoking. And it was essentially a first very public step in a campaign that, one could argue, in many ways has persisted ever since, although, obviously, now the tobacco companies admit that they're killing their customers and they admit that smoking causes cancer and heart disease and lung disease and so on. But that was kind of the beginning of the strategy that drove their behavior for decades.   You know, that was one of the issues we raised in our paper. How similar were the big food companies in talking about concern for the health of their customers, planting doubt with the science, pledging to make changes that were in the interest of public health, agreeing to collaborate with public health officials? All those things played out in the food arena as well. And that's just one of many places where the food industry behave very, very similar to what the tobacco industry has done. But boy, is it interesting to hear that particular anecdote and to learn of the cynical behavior of the industry. So fast forward from there, and you think about the tobacco industry executives testifying before Congress that nicotine wasn't addictive, and you have that same process playing out many years later. These similarities are really remarkable.   So let's talk about your work and some of the issues that I think apply to the food area, and let's talk about taxes at the beginning. So I worked for years on the issue of soda taxes, and these taxes now exist in more than 50 countries around the world and in a number of major cities in the US, including San Francisco, Philadelphia, Seattle, and Oakland. And these taxes have been shown to have really positive effects, and they seem to be growing around the world. And I'd like to understand what you see as the overall findings from the work on tobacco taxes. But before we do that, you have a very interesting story to tell about how the tobacco control community responded when you first began speaking about taxes. It turns out to be taxes on tobacco have had whopping effects. But what was the initial reaction to people in that field?   Yeah, it is kind of an interesting story. So around 1980, when I first started writing and talking about tobacco taxation as a method of reducing smoking, I used to have public health audiences booing me. If they had rotten tomatoes with them, they would have been throwing them.   You know, Ken, it's hard to imagine because now these taxes are completely routine and accepted.   Yes, they're not only routine and accepted, they are a first principle of tobacco control. They are enshrined in the World Health Organization's Framework Convention on Tobacco Control. So they really are kind of the first thing we turn to because we know that they work. We know that they reduce smoking.   But let me give you a story about how I learned that this is not only a phenomenon with people smoking. It's a phenomenon with people using all other drugs, and it turns out it's a trans-species law, the Law of Demand. And that law says, basically, that if you increase price, the demand for the commodity will decrease. Well, in the beginning, the public health audiences believed two things. They believed that smokers were so addicted that they would not be affected by price, so it was ridiculous to even think about it. And they said, you have to have intrinsic motivators to get people to quit smoking. They have to care about their kids. They want to see their kids grow up, their spouses, and so on, and not extrinsic forces like a tax. So those were their two objections. So the story that I think is really kind of fun. I was on a plane flying to a small conference in Kansas City. This is sometime in the early '80s. And I happened to be seated next to Jack Henningfield, who is probably the preeminent psychopharmacologist dealing with nicotine, maybe in the world. And we were talking about price response, the fact that cigarette taxes work. And he said, "You know, I've got something I want to show you here." And he pulled out some what are called response cost curves from the psychology literature. And this is where you take a laboratory animal, in this instance addicted to narcotics or other addictive substances, and you give them a challenge to get their drugs. So first, I should note that these animals are so addicted that if they're given the choice between food and their drug, they will choose their drug, and they will in fact end up dying because they place a preference for the drug over food. But it turns out that when you increase the price of the drug to them, they decrease the amount that they consume. So what do I mean by that? If they have to push a lever, a bar, a certain number of times to get a dose of their drug, and you raise the number of bar pushes per dose, they will dose themselves with fewer doses. I took a look at these curves, and basically, a response cost curve for these lab animals is essentially a demand curve as we economists see it. And I calculated the price elasticity of demand, which is our standard measure of the responsiveness to price. And it turns out that addicted laboratory rats have essentially the same price elasticity of demand, the same price responsiveness that human beings do to cigarettes.   That's an absolutely fascinating story. And, you know, I know Jack, and have admired his work, as you have, and it's amazing to think about that conversation on a plane, and what sort of scientific work it led to, and how that, in turn, found its way into policies that exist around the world. So tell us then about tobacco taxes, and how high do they have to be in order to affect consumption in an appreciable way, and have they worked in reducing tobacco use, and what's your overall take on that?   So we have, quite literally, hundreds of studies in countries around the world, and we know a lot but we don't know everything. So we don't know, for example, if there's a particular price above which, you know, nobody will use the product. We don't have even really good data suggesting of, you know, what's the minimum increase in price that you have to have to have a noticeable impact. Overall, the literature suggests that if you increase the price of cigarettes by 10%, you will decrease the quantity demanded by 3 to 4%. Now, what this means is that roughly half of that decreased demand reflects decreases in the number of cigarettes that continuing smokers use, while the other half represents decreases in smoking, people quitting or kids not starting. So the demand is what we call price inelastic. The price change itself is larger, proportionately, than the decrease in consumption. But that decrease in consumption is still substantial and it's enough to have a large impact.   Now, cigarette prices vary all over the world, and cigarette prices vary primarily because of taxation differences. So if you go to the Scandinavian countries, you'll find that a pack of cigarettes will run $15 or more. If you go to Australia, you're looking at $30 or more a pack. In the US, currently, we're looking at an average price in the range of about 7 to $8. In some jurisdictions, like New York City, it's $10 or more. But the prices in the US are actually relatively low among the more developed nations in the world. Any tax increase will have an impact but obviously the larger tax increases will have larger impacts. And there's some good and bad news in tobacco taxation, particularly in a country like ours, and this is, again, true for most of the developed world. Smoking is now concentrated in marginalized populations. I'm talking about low socioeconomic groups, the LGBTQ community, and racial minorities, in particular. If you think of this as an economic phenomenon, when you raise the price on cigarettes, you're going to hit the worst-off economically segments of the population hard. That's the bad news. The good news is that those people, precisely because they are poor, tend to be much more price responsive than high-income smokers, and more of them will quit. So we have this problem that the tax is regressive, it imposes a larger burden on the poor, but the health effect is progressive. It will reduce the gap between the rich and poor in terms of smoking rates. And of great importance, there's an enormous gap between the rich and poor in this country in life expectancy, and as much as half of that may be differences in smoking rates.   Ken, there's a hundred follow-up questions I could ask, and I find this discussion absolutely fascinating. One thing that came into my mind was that some years ago I looked at the relationship of taxes, state by state in the US, and rates of disease like lung cancer and heart disease. And there was plenty of data because there was a huge range in tobacco taxes. Places like New York and Rhode Island had very high taxes, and the tobacco Southern states, like North Carolina, had very low taxes. But what's the sort of recent take on that, and the relationship between taxes and actual disease?   Well, it's still true. And there are, in fact, what you suggest, the southeastern block of tobacco states have unusually low rates of taxation. And I haven't seen any recent data but one presumes that they are suffering more from smoking-related diseases because their smoking rates are higher. I mean, that has to be true. So I don't know that we have any particularly good data recently, but there have been studies that clearly relate tobacco or cigarette prices to health outcomes associated with smoking.   I'm assuming US scientists have played a prominent role in producing the literature showing the negative health consequences of using cigarettes, and yet you said the United States has relatively low taxes compared to other developed countries. Why, do you think?   I think we're going to get into a very philosophical discussion about the US right here. It has to do with individual responsibility. We know for sure that the initial reason the taxes were so low was that the tobacco block was so influential in the Senate, particularly in the days when Jesse Helms, the senator from North Carolina, was in the Senate. He was the most feared senator by the other senators, and if you wanted to get anything done for your cause, you had to go along with his cause, which was keeping cigarette prices low and doing everything they could to support smoking. So there's clearly been a built-in bias in the Senate, and basically in the Congress as a whole, against tobacco policy. You see a huge variation from state to state in tobacco policies, and it's reflective of basically their political leanings in general.   You brought up this issue of personal responsibility, and boy, does that apply in the food area. You know, the food companies are saying: if you have one sugar beverage every once in a while, it's not going to be harmful. And it's not use of the products but it is overuse of the products. Thereby saying, it's not corporate responsibility we're talking about here, it's personal responsibility. That same argument was made by the tobacco industry, wasn't it?   It was. They would be less inclined to do that today, for a couple of reasons. One is that we know that even low levels of smoking are harmful and indeed cause many of the diseases that we were referring to earlier. And I think all the companies have now admitted publicly that smoking does cause all of these diseases that we've long known it causes. And all of them are claiming that they would like to move away from a society with smoking to one that has alternative products that would give people choices and ways to get their nicotine without exposing themselves to so much risk. I mean, we have to remember, the fact that cigarettes kill their consumers is a real drawback as far as the industry is concerned because they're losing a lot of their consumers, you know, 10, 20 years before they normally would, and they have to deal with all these lawsuits. So it's unfortunate for them. Having said that, cigarettes are the goose that lays the golden egg. They cost very little to manufacture. The industry is sufficiently oligopolistic that the profits are enormous, and their profitability has continued even while smoking has dropped rather precipitously ever since the mid-1960s.   Is that because the markets outside the US have been growing?   They certainly have helped. Although now, and this is only true within the last few years, the aggregate cigarette sales in the world are declining. They've actually started dropping. So we were seeing a relatively stable situation as smoking decreased in the developed world and was rising in the developing world. The only place now where we're seeing increases in smoking are areas in Africa, which, by the way, is the one place in the world where we might be able to forego the tobacco epidemic because smoking rates are still quite low in most of the countries, not all of them, and also parts of the Middle East. But elsewhere we've been seeing smoking declining all over the world. That doesn't mean the profits have to drop because one thing that the companies can do, is, they can raise their prices. Now, if prices go up because of taxes that hurts the companies. But if they raise their own prices because demand is inelastic, what that means is that the percentage increase in the price is larger than the percentage decline in the demand for cigarettes. So they're actually adding to their profitability by doing that. They've always played this very interesting game for years of keeping price below what we would think to be the profit-maximizing price. And I think the reason for that has to do with addiction because they know that they have to have what are called replacement smokers, kids coming in to take the place of the smokers who are dying or quitting. And for years, I think, they kept their prices down because they didn't want to discourage young people from smoking. Now, I think they see the writing on the wall. Smoking is declining very rapidly. Smoking prevalence, which was 45% in the mid, early-1960s, is now a little over 12% in the US, and I think they're raising their prices with the understanding that they want to take as much advantage of the opportunity with the addicted smokers, the adults, as they possibly can, even though smoking among kids is becoming vanishingly small.   I think of so many parallels with the soda taxes that now exists in a number of places, and the companies have responded somewhat differently. And perhaps it's the level of addiction issue that kicks in here, and the need to have replacement customers. Maybe that's another key difference. But with the soda taxes, the companies have not increased prices beyond the level of the tax. You know, to delight of public health experts, the companies have tended to pass along the entire tax so the companies are not eating that difference in order to keep prices the same. Higher tax gets reflected in the ultimate price that they charge, but they're not increasing prices beyond that. Do you think it might be the addiction issue that's different here?   I don't know. I mean, that certainly could be an element of it. The other thing is that they're manufacturing other drinks that are being used in place of some of the sodas. So they've got waters, they've got juices. I mean, obviously these sugary juices are no better, but they do make other products. They make the diet drinks. And to the extent that they can find substitutes for those products within their own companies, it may be that they're content to allow people to make those substitutions.   Interesting comment. The results so far on the soda tax suggest that the most common substitution as people drink less soda, is water, which is of course better than a lot of the alternatives that people might be consuming, so that's a bit of really good news. Even though the companies do sell water, Coke and Pepsi have Aquafina and Dasani, for example, they face a basic problem. Number one is that these companies are the biggest sellers of sugary beverages but not bottled water. That happens to be Nestle. So if people migrate to bottled water, they're likely to migrate from the big companies, like Coke and Pepsi, to Nestle. Also, people tend not to be very brand-loyal to water. They tend to buy whatever is on sale or whatever they find available to them, and that creates a problem for these companies like Coke and Pepsi that do rely on brand loyalty for their marketing. So it's very interesting. And also, I wonder, based on the research on food and addiction, if the companies don't take a hit if people switch from full sugar beverages even to diet beverages that they might sell because there wouldn't be as much addictive potential, and therefore the customers wouldn't have to have as much just to keep the habit going. So it's really interesting to think this through.   That's certainly very plausible. The whole thing would also depend on the price elasticity of demand for sodas, and specifically for the brands that they're concerned about. If there is greater elasticity there than what we observe for cigarettes, then raising those prices aren't necessarily going to help them all that much.   You mentioned that the elasticity estimates for tobacco suggested that a 10% increase in price led to a 3 to 4% reduction in consumption, and the numbers are even more positive in the case of the sugar beverages, where if you get a 10%, 15% increase in price, you end up with 10, 15% reduction in consumption. So that's good news in the food arena.   That's good news but it also means that they can't do as easily what the tobacco industry can do, which is to raise their prices and expect to see profits rise. Because if they're losing as much in sales as they're gaining in price, it's no win.   So Ken, let's talk about product formulation because you mentioned that earlier, and this is a really interesting issue that, again, connects tobacco and food products. So you think about the tobacco companies mainly selling cigarettes, but now there's vaping, there's cigarettes with things like menthol and other flavors, or low-fat foods, or artificial sweeteners. The list of product reformulations in order to attract customers goes on and on and on. So I know a controversial topic in your field has been e-cigarettes. Can you explain what these are?   E-cigarettes have been around now for about a decade, let's say. Basically, they're devices that allow people to inhale nicotine and other substances, but the purpose is to give them their nicotine without combustion. And we know that the major problem associated with smoking is the products of combustion. There's 7,000 chemical compounds in cigarette smoke. 70 of them are known human carcinogens, causes of cancer in humans. Many of them are cardiotoxic. They cause lung disease and so on. The e-cigarettes have about two orders of magnitude fewer toxins in their emissions than do cigarettes. And it turns out that the amount of the comparable toxins, when they are in fact comparable, that you find in the e-cigarette emissions is much lower, usually a 10th to a 400th, of what you find in cigarette smoke.   So logically, and based on a fair body of evidence at this point, vaping, use of e-cigarettes to get nicotine, is substantially less dangerous than is cigarette smoking. However, the controversy here is incredible. This is the most divisive issue that I have witnessed in my 45 years of working in the tobacco control field. It has torn the field asunder. The mainstream of public health, and by that I'm including governmental agencies, the Campaign for Tobacco-Free Kids, the Truth Initiative, the American Cancer Society, heart and lung associations, all of mainstream public health is strongly opposed to e-cigarettes, and for one reason. They're concerned about kids' uptake of e-cigarettes, which has been substantial. It's been decreasing the last couple of years, but it has been substantial. And there are a number of things they're concerned about in that regard, and they're completely ignoring the fact that there's pretty good evidence that e-cigarettes are increasing smoking cessation for a subset of smokers. And a number of us on the science side of this, believe that the net effect of e-cigarettes is beneficial, that it's actually, possibly, a tool to add to the armamentarium of things like cigarette taxation, like smoke-free workplaces, like restrictions on advertising, and that it will help a group of inveterate smokers, those who either can't quit nicotine or don't want to, to move to a less dangerous alternative to smoking. I am not saying that e-cigarettes have no risk associated with them. They almost certainly do. But it is substantially lower.   Now, historically, this is divisive within the field in part because all of the earlier attempts at, quote-unquote, tobacco harm reduction have been produced by the major cigarette companies, and they've been fraudulent. So cigarette filters were manufactured and sold, starting in the 1950s, in response to the scare that I referred to earlier about cancer. And they were sold with a message that the filters block the dangerous stuff but let the flavor through. And people bought this. That decrease in smoking in the early 1950s reversed, smoking went up sharply, as sales of filtered cigarettes went up. By the way, the first successful filtered cigarette was Kent, and it used what it referred to as the miracle Micronite filter. Well, that miracle Micronite filter turns out to have been made of asbestos. And there are lawsuits continuing to the present day by workers in the factories that made the filter tips for Kent cigarettes, who themselves ended up with lung cancer or other diseases due to the asbestos. Then came low-tar and nicotine cigarettes, and we actually have ample evidence from the documents that had been revealed by lawsuits, that the industry knew that this was a public relations device. It was not a harm reduction device. And in fact, because people believed that low-tar and nicotine cigarettes were less dangerous, it's likely that it actually increased the toll of smoking because people who would have quit, switched to low-tar and nicotine cigarettes instead. So there's some pretty awful history here that makes people legitimately concerned about alternative products. A critical element of this story is that the alternative products, in this case, the e-cigarettes were introduced by non-cigarette, non-tobacco companies, and their goal was to replace smoking. Now the major companies are all making their own e-cigarettes as well because they have to do it from a defensive point of view, but basically they don't have any great interest in slowing up the sale of cigarettes. They want to benefit from that as long as they can.   So I should know the answer to this but I don't, but are e-cigarettes taxed? And wouldn't it be optimal to tax e-cigarettes but less than regular cigarettes so you discourage use of both but discourage the use of regular cigarettes more?   That is very insightful. Two colleagues and I actually published a paper saying that in 2015 in "The New England Journal of Medicine," that we should be taxing e-cigarettes modestly, the reason being that we want to discourage kids from using them, and kids are far more price-sensitive than our adults. Kids have a very elastic response to cigarette prices. Adults do not, and in particular, older adults have even lower price responsiveness. So yes, there should be some taxation of e-cigarettes to discourage youth use of it but that taxation should be dramatically lower than the taxation of cigarettes. Some states are now taxing e-cigarettes. Not all of them. The federal government is actually looking into a proposal to double the tax, the federal tax, on cigarettes, which would take it up to $2.01 a pack, and at the same time, to establish an equivalent tax, similar to the $2 tax, on all vaping products. This would be a disaster because it would definitely discourage kids from vaping, but it would also discourage adults from using e-cigarettes as an alternative to smoking, and the most addicted, the inveterate smokers, those are the ones that need these alternatives. So that's a bad policy proposal. A much better one would be to increase the cigarette tax by more than a dollar, raise it to 3 or $4 or something, and impose a modest tax on e-cigarettes. This would discourage people from smoking, both adults and kids, but especially kids. It would discourage kids from using e-cigarettes but it would create a price differential that would encourage the inveterate smokers to switch to e-cigarettes. Now, part of the problem, and this has gotten worse over time, is that the American public believes that e-cigarettes, that vaping, is as dangerous and even maybe more dangerous than cigarette smoking. Nothing could be further from the truth but so far the mainstream of public health has sold that message to the public, and the public, including smokers, believe it.   That's a fascinating story about how the public health field might be getting in its own way with this.   And maybe doing damage to public health.   So let's loop back a little bit to the behavior of the tobacco industry. So in 2017, the Phillip Morris Company funded and launched an organization called Foundation for a Smoke-Free World. So I think, hmm, a tobacco company saying they want less smoking, and one could view this with pretty high cynicism but what do you think about it?   I've always shared your sense of cynicism about it. There's an interesting anecdote related to this. The individual who negotiated the deal by which Phillip Morris offered $1 billion over a 12-year period to establish this foundation, that individual was the main actor in the World Health Organization during the development of the global treaty on tobacco control, the Framework Convention on Tobacco Control. He also became director of the organization and served in that capacity until just the other day. He has stepped down from being director. But let me give you a little context for it. Philip Morris International that needs to be distinguished from Altria and Philip Morris Domestic, but Philip Morris International sells the leading brand of what is known as heated tobacco products, HTPs. These are products that actually have tobacco in them. E-cigarettes have no tobacco in them but these products actually have tobacco in them. But instead of burning the tobacco, they heat it. They volatilize it, and the nicotine is inhaled. Like e-cigarettes, they appear to be substantially less dangerous than smoking, although it's not clear that they're as less dangerous as, than, e-cigarettes. But they're produced only by the major cigarette companies. Philip Morris is now selling these products successfully in many countries, many cities around the world. While they actually have the authorization to sell an older version of the product in the US, it's not very popular at this point. But in Japan, over the last four years there's been a drop in cigarettes sold of about a third at the same time that there's been this great increase in the use of these heated tobacco products manufactured by Philip Morris International and by Japan Tobacco. They have a product called Ploom. Philip Morris' product is called IQOS, I-Q-O-S, which, I was told, originally stood for I Quit Ordinary Smoking. So they are the leader of the theme song that the industry is singing these days about how they want a smoke-free world and they want to move toward one. But the only way they're ever going to do that, willingly, is if they can sell other products like these heated tobacco products and make large sums of money on them. Philip Morris has a good start at that. They claim that about a third of their revenue now is coming from IQOS, this heated tobacco product.   So whether that foundation ultimately has beneficial effects or not, forget corporate beneficial effects but on the public good, would pretty much depend on who's choosing to use these e-cigarettes, I'm imagining. That if it's people switching from normal cigarettes to them, or using them instead of normal cigarettes, it's one thing. But if they're recruiting new people who otherwise wouldn't smoke, then it would be a bad thing. So how do you think that'll all play out?   That's actually a critically important question, Kelly. And one of the great concerns that the opposition to e-cigarettes has, is that they're addicting lots of kids to nicotine, and that many of them will go on to smoke, and that that will reverse the progress that we made on smoking. Now, it turns out that there is no evidence to support the latter contention. And in fact, there's evidence to the contrary. I think it's entirely possible that some kids who would not have touched a cigarette otherwise are vaping and then trying cigarettes in the future. Whether they become regular smokers, remains to be seen. But I think there certainly are some kids like that. But what we do know is that the rate of smoking among kids, what we call current smoking, and smoking among kids means that they've had at least one puff on a cigarette in the last 30 days, that number has plummeted over the last quarter century, and, and this is the interesting thing, it has gone down at its fastest rate precisely during the period in which vaping has been popular among kids.   So one theory is that vaping is displacing smoking to some extent. That kids who would've smoked are vaping instead. It's a very complicated area and we don't know the answer. Among adults who vape, and they are relatively few in number except for very young adults, we observe mostly dual use, but the question is how much of this is a transition to vaping only, and then, maybe, a transition to nothing after that. In the UK, where vaping has been advertised by the health organizations as a way to quit smoking, and they have encouraged its use, and they use it in their smoking cessation clinics, and you'll even find it in hospitals, in the UK we have seen that more than half of the people who have quit smoking by using e-cigarettes have also quit vaping. So it is no longer the case in the UK that a majority of the people who vape are also currently smoking.   In the US, the data have been moving in that direction but it's still a majority who are dual users rather than vaping only. But we have evidence of four or five completely different kinds of studies, commercial data, other products in other countries, that all lead to the conclusion that vaping is already increasing the rate of smoking cessation in the US and in the UK by probably 10 to 15%. That's a hard thing to see in the data but it is something that, if you dig into the data, you will see it, and as I say, we see it all over the place. Let me give you one example of the tobacco harm reduction story that's fabulous. 40 to 50 years ago, large numbers of Swedish males started using a smokeless tobacco product called snus, S-N-U-S. It's a relatively low nitrosamine product, nitrosamine being a carcinogenic element, and they substituted it for cigarettes largely because cigarette taxes were going way up and there weren't any significant taxes on snus. So what you observe today, some three, four decades or more later, is that Swedish males have the lowest male smoking rate of any country in Europe, and maybe in the world. They do not have a low tobacco use rate. Their tobacco use rate is pretty typical but it consists mostly of snus. And they also have by far the lowest rate of tobacco-related diseases, like lung cancer, of men in all of the European Union countries, and the second lowest is typically a rate twice or more that of what you see in the Swedish males. Swedish females, who did not quit smoking in large numbers and did not take up snus until fairly recently, have rates of lung cancer and other diseases that are average or above-average for the European Union. So that's a great example of tobacco harm reduction in action, and it's one that's been around now, as I say, for decades.   Ken, this is a remarkable history and you're just bringing it alive beautifully. But let me ask you one final question. So given that you've been working in this field for more than four decades now, and have really been a pioneer, a leader, a warrior, and a hero, all those things could be applied to you and your work, if I asked you to sum up what's been learned from all these decades of work on tobacco, what would you say?   There are a lot of lesson. Certainly, we have learned specific kinds of interventions that really matter. You and I spoke about tax at some length. That's the preeminent one. Smoke-free workplaces, including smoke-free restaurants and bars, have not only themselves had a direct impact on health but have also set the tone for a more smoke-free society. So we have seen quite dramatic changes. I mentioned we're going from a 45% rate of smoking for the nation as a whole down to a little over 12%. That, however, has taken us six to seven decades. So it's kind of a good news, bad news story. It's a very complicated area. Tobacco control was ranked by CDC as one of the 10 most important public health measures of the 20th century, and also the first decade of the 21st century. And I think that's completely legitimate, and it is something about which all of us who care about public health can feel very proud about. The problem still remains. It is an enormous problem, as you alluded earlier, in many parts of the developing world, the low- and middle-income countries, and it's a growing problem in some of those countries, and it's just not going to disappear real fast. The lesson that I've taken most recently has been a discouraging one, and that's how divisive our field has become. We really have a chasm between the people who are opposed to tobacco harm reduction and those who are supportive of it. They're good people on both sides, they believe what they're saying, but they can't talk to each other civilly at this point. I hope that that will not become the case for those of you who are fighting the good fight in dealing with unhealthy foods.   Bio   Kenneth E. Warner is the Avedis Donabedian Distinguished University Professor Emeritus of Public Health and Dean Emeritus at the University of Michigan School of Public Health. A member of the faculty from 1972-2017, he served as Dean from 2005-2010. Presented in over 275 professional publications, Dr. Warner's research has focused on economic and policy aspects of tobacco and health. Dr. Warner served as the World Bank's representative to negotiations on the Framework Convention on Tobacco Control, WHO's first global health treaty. He also served as the Senior Scientific Editor of the 25th anniversary Surgeon General's report on smoking and health. From 2004-2005 he was President of the Society for Research on Nicotine and Tobacco (SRNT). He currently serves on the FDA's Tobacco Products Scientific Advisory Committee. In 1996 Dr. Warner was elected to the National Academy of Medicine. He is a recipient of the Surgeon General's Medallion, the Luther Terry Award for Exemplary Achievement in Tobacco Control, and the Doll-Wynder Award from SRNT. Dr. Warner earned his AB from Dartmouth College and MPhil and PhD in economics from Yale University.  

For nearly 70 years now, Americans have been bombarded with advice on how to lose weight. Countless diet books have become bestsellers. Some diets like Atkins keep coming back in sort of a recycled way. And there really hasn't been agreement, even among nutrition scientists, about which approach is best. Lots of attention has focused in recent years on carbohydrates, but over the years, protein and fat have had plenty of attention. In this podcast, our guest, Dr. David Ludwig of Harvard University, discusses this history and the reason for re-envisioning how best to lose weight – and for people to maintain the weight loss, perhaps the most important issue of all. Ludwig recently published a landmark, exquisitely designed and controlled study that tests whether limiting carbohydrates actually makes sense. This study, published in the "American Journal "of Clinical Nutrition 2021," has been generating lots of attention.   Interview Summary   Access the study: https://doi.org/10.1093/ajcn/nqab287     I'll begin by asking a question fundamental to this work. Why care so much about carbohydrates?   Great question, Kelly. Carbohydrates amount to at least half the calories in a typical diet today, which is interesting from a historical and evolutionary perspective. Because of the three major nutrients we eat, protein, fat, and carbohydrate, carbohydrate is the only one for which humans have virtually no requirement. Think of Northern populations, especially in the Ice Ages but also up to recently, such as the Inuit, that had access to only animal products and could eat plant products like berries maybe one or two or three months a year at most. So for nine months a year, they were eating only fat and protein. And yet, those populations were healthy. The women were fertile; they could breastfeed. And children grew normally. So recognizing that there's no absolute requirement for carbohydrates, the question then becomes: How much carbohydrate and what kind would be optimal for health and allow for the greatest flexibility, diversity and enjoyment in our diets?   So David, if the body doesn't have an innate need for these, presumably there's no biological driver to go out and seek these, why in the heck are people eating so much of this?   Well, carbohydrates are delicious. And the food industry certainly knows that and has taken advantage of that. In fact, when you step back and ask: What are the foods that we tend to binge on? They may have a combination of key flavors and nutrients. Oftentimes, we hear sugar, salt and fat. But I'll argue that there are virtually no binge foods that are just fat. Do people actually binge on butter? I mean, butter is very tasty. You might enjoy an initial bite. But very few people, perhaps with the exception of a major eating disorder, would sit down and eat a quarter pound, a stick of butter. But there are all sorts of high-carbohydrate binge foods. Sugary beverages are 100% sugar. Bread, baked potato chips, popcorn, especially the low-fat versions, these are easy to binge. And from one perspective, the key difference is the hormone insulin. Fat does not raise insulin. And so fat is digested slowly, and doesn't get directly stored in large amounts into body tissue. It has to be metabolized more slowly. Whereas carbohydrates, especially the processed ones, when eaten in large amounts, raise insulin to high levels. That insulin directs those incoming calories into storage. And a few hours later, blood sugar crashes and we get hungry again and are ready to have another blood sugar surge by indulging the next time in those foods.   So what question specifically was your study designed to address?   We conducted a large feeding study that had two parts. The parent study had 164 young and middle-aged adults, who were at least a little bit overweight, ranging from overweight to having obesity. And the first thing we did was bring their weight down by providing them all of their foods, delivered foods to their home, in a calorie-restricted way. You know, you cut back calories, and of course you're going to lose weight for a while. It doesn't address why people get hungry, and why they regain weight. But in the short term, we cut their calories, and they lost 10% to 12% of their weight. Then we stabilized them at their new, lower body weight, and then randomly assigned them to one of three groups: low, moderate or high-carbohydrate diets. And we kept them on these three different diets for another five months. And during this time, we were again delivering all of the meals to the participants. This was over 100,000 prepared meals throughout this time, so it was a really major effort. And during this low, moderate, and high-carbohydrate diet period, we adjusted calories to keep their weight the same. We wanted to keep them at that weight-loss anchor, 10% to 12% below where they started. The first study looked at what happened to their metabolism and their energy expenditure. And we found that when people were on the low-carb diet at the same weight as the other groups, they were burning about 200 calories a day more. So the study raised an interesting possibility, that the kind of calories you eat can affect the number of calories you burn. That from a biological perspective, all calories are not alike to the body.   David, this is fascinating work. I'd like to ask a strategy question. So this was an extremely intensive study of 164 people. And you mentioned the people were provided all their meals, very careful measurement and things like that. So the same amount of money, you could have studied many more people but just done a less intensive study with less supervision and fewer measurements of outcome. So why do the study in such an intensive way?   Right, there's always going to be a trade-off in design considerations. And you've identified a classic trade-off. You can study fewer people more intensively, or more people less intensively. Most weight loss trials have chosen the second route. They take a lot of people, and they try to study them for a long period of time, or at least some of them do: a year or ideally two years or longer. The problem is that without an intensive intervention, so what are we talking about? These studies would oftentimes have participants meet with a nutritionist once a month. They would get written educational materials, and maybe other kinds of behavioral support. But that's about it. And without greater levels of support and intervention, people characteristically can't stick to these diets over the long term. Maybe they make changes for two, three or four months. But by six months or a year, they're largely back to eating what they were originally. And the different diet groups don't look much different. So if the groups didn't eat in much of a different way throughout most of the study, why would we expect to see any differences in outcomes, such as weight or energy expenditure, or cardiovascular disease risk factors? So these studies don't test a dietary hypothesis very well. It leads to the mistaken conclusion that all diets are alike. Really, what the conclusion of these studies has to mean is that we need more intensive intervention in our modern toxic environment, if you will, to promote long-term change. And it's only when we get that long-term change can we actually figure out which diet is better and for whom.   So you've explained how the study was done and why you did it. What did you find?   So the first leg of the study, which was published in "BMJ" late in 2018, so just before the pandemic, showed that the kinds of calories you're eating can affect the number of calories you burn. And, that by cutting back on the total and processed carbohydrates, you can increase your metabolic rate. And that could be a big help in the long-term management of a weight problem. You know, you want your body on your side rather than fighting you when you're trying to maintain weight loss. And a faster metabolism would be a tremendous help if this is a reproducible finding and applies to the general population. We recently published in the September "American Journal of Clinical Nutrition," a second part of the study. And that asks: How do these different diets, low, moderate and high carbohydrate, affect cardiovascular disease risk factors? It's one thing to lose weight. Maybe a low carbohydrate diet helps you lose weight. But if your cardiovascular disease risk factors go up, that might not be such a good trade-off. So that's the aim of the second study. Because low-carbohydrate diets are often very high in saturated fat. So we wanted to find out what were the effects of this low-carbohydrate, high-saturated-fat on a range of risk factors.   So tell us specifically some of the cardiovascular risk factors that changed. And if you would, place the changes that you found in your participants in a context. Like are these big-deal changes? Are they small changes? Or put it in context, if you would?   The big problem with saturated fat is that it clearly raises LDL cholesterol, low-density lipoprotein cholesterol, which is a classic cardiovascular disease risk factor. It's the main one that's targeted by many of the drugs, such as statins. Yeah, I think there's no question that on a conventional high-carbohydrate diet, a lot of saturated fat is harmful. So the combination of bread and butter is not a good one. But the question we wanted to ask was: What happens when you get rid of a lot of that bread? Does the saturated fat still comprise a major risk factor? And so our low-carbohydrate diet was exceptionally high in saturated fat, as is characteristic of how these low-carb diets are usually consumed. It had 21% saturated fat, which compares to the 7% saturated fat on the high-carb, low-fat diet that's oftentimes recommended to people at risk for heart disease.   So what did we find? Well, the first thing we found was that LDL cholesterol was not adversely affected at all. There was no difference in LDL cholesterol between those getting 21% versus 7% saturated fat. Suggesting that when you substitute saturated fat for processed carbohydrates, from the standpoint of this key risk factor, it's pretty much a wash. However, the low-carbohydrate, high-saturated-fat diet benefited a range of other risk factors that go along with what we call the metabolic syndrome, the insulin resistance syndrome. Specifically, we saw strongly significant, from a statistical perspective, improvements in triglycerides, that's the total amount of fat in the bloodstream; HDL cholesterol, that's the good cholesterol that you want to be higher; and other lipids that indicate overall levels of insulin resistance. Suggesting that insulin resistance was improving. And we know that low-carbohydrate diets show promise for diabetes in other studies, in part because they do tend to improve insulin resistance and lower blood sugar. And so our study suggests that if you are pursuing a low-carbohydrate diet, and we can talk about the different degrees of restriction of carbohydrate, and at the same time you're reducing the processed carbohydrates, then the saturated fat might not really be such a problem.   So then if you take all this information in this, as I said, exquisitely designed intensive study and distill it into what dietary recommendations would be, what do you think is a reasonable proportion of fat, carbohydrate and protein in the diet? And what sort of things should people think about as they want to lose weight and keep the weight off?   One key qualification I need to mention is even though this was an intensive study with a relatively large number of people for a feeding study of this magnitude, we still don't know how generalizable these findings are to people at different ages, different body weights, different levels of susceptibility. So no one study can inform a change of clinical practice like this, especially in the world of nutrition where there's so many complicated and interacting factors. I will also venture to say that there's no one diet that's going to be right for everybody. We know that some people can do perfectly well on a high-carbohydrate, low-fat diet. I mean, think of the classic Asian agrarian societies where rates of obesity and diabetes are very low. But those societies tend to be highly physically active and the people insulin-sensitive. America is characterized by high levels of overweight and obesity, sedentary lifestyle. And these create insulin resistance as a highly prevalent problem. For societies such as ours, we think that high-carbohydrate diets that are raising insulin levels on the background of insulin resistance is a recipe for metabolic problems. And so for Americans, especially those struggling with weight, pre-diabetes, and even more so diabetes, a reasonable first step is to cut back on the processed carbohydrates. And I think that's an intervention that increasingly few experts would argue with. We're talking about concentrated sugars and refined grains. Where we start to get into the controversy is whether carbohydrates should be further reduced down to say 20% as in our study, which still leaves room for some unprocessed grains, beans, and a couple of servings of whole fruit a day, or even lower to what's called the ketogenic diet that's less than 10%. And that's where you really have to give up most carbohydrates and focus just on the proteins and fats. I think for people with diabetes, such a strict approach looks appealing in preliminary research studies. But again, this is going to need more research. And I would caution anybody with diabetes or anybody who's thinking about a ketogenic diet to discuss these kinds of dietary changes with their healthcare provider.   I realize your study wasn't meant to address this issue that I'm about to raise, but I'd appreciate hearing your instincts. One key, of course, to any recommended nutrition plan or diet, if you'd like to call it that, is whether people will stick to it. What do your instincts tell you, or data if you have it, on how readily people can adhere to this sort of an approach over the long term compared to other kinds of approaches?   Great question. And I'll approach that by saying: We all understand that if diet is a problem that's contributing to obesity, diabetes, heart disease, other chronic health problems, then we have to change our diet in one way or another regardless of what the mechanisms are. So I'll return the question to you by saying: Which do you think is going to be easier for most people over the long term: cutting back calories, getting hungry and trying to ignore that very intense drive to eat, or getting rid of certain kinds of foods that may be triggering hunger and making it so much harder to stick to a lower calorie intake?   As a doctor, as a pediatrician, and as a researcher, and also myself, I try to do N of 1 experiments on myself with any kind of a nutrition approach I might use with patients or with research participants. I've found that it's so much easier to just give up the processed carbohydrates and enjoy a range of other very satisfying, delicious, higher fat foods. And oftentimes, in my experience personally and I hear as reported by patients that the cravings for these highly processed carbohydrates go down. And lastly, I'll just say, it's not that these processed carbohydrates are inherently so irresistibly delicious. I mean, white bread, these common binge foods, white bread, unbuttered popcorn, baked potato chips, even though these are almost 100% carbohydrate yet they're commonly binged on not because they're so incredibly tasty. But I would argue because they're producing changes in our body that are driving overeating. So it's not that they're so tasty and we're getting so much enjoyment. We're eating these foods because we're driven to metabolically. And once you come off that blood sugar rollercoaster, it becomes much easier to say no.   When you mentioned before that with one approach, you're kind of fighting your body; and another approach, your body is becoming your ally in this process, I thought of going to the beach and, you know, you can go out and try to swim against the waves coming in, or you can ride the waves toward the beach. And one, of course, is a lot easier than the other. And it sounds that's kind of what you're talking about, isn't it?   When you line up biology and behavior, and clearly behavior, psychology, and our food environment are all factors that are going to have to be addressed. We don't want to make it much harder for people. So we do need to think in systems dynamics: the food supply, the environment. But on a strictly individual level, when you line up biology with your behavior, the effort required to accomplish your goals becomes less. You know, this is characteristic of so many areas of medicine and research. This is why we aim to identify the cause of a problem when you treat a cause. So let's use the example of fever. Fever you could say is a problem of heat balance: too much heat in the body, not enough heat out. And so from that perspective, you could treat any fever by getting into an ice bath. Couldn't you, right? The ice would pull the excess heat out of your body. But is that an effective treatment for fever? No, of course not. Because your body's going to fight back violently with severe shivering, blood vessel constriction. And you're going to feel miserable and you're going to get out of that ice bath quickly. In the case of obesity, the timeframe is much longer, but similar kinds of responses occur. The body fights back against calorie restriction because calorie restriction, according to this way of thinking, is an effect. It's not the cause. If the cause is the body's been triggered to store too much fat, then we have to address that problem by lowering insulin levels and producing a more stable blood sugar pattern after eating. If that happens, then the effort that you put into cutting back calories goes a lot further.   Bio:   David S. Ludwig, MD, PhD is an endocrinologist and researcher at Boston Children's Hospital. He holds the rank of Professor of Pediatrics at Harvard Medical School and Professor of Nutrition at Harvard School of Public Health. Dr. Ludwig is the founding director of the Optimal Wellness for Life (OWL) program, one of the country's oldest and largest clinics for the care of overweight children. For 25 years, Dr. Ludwig has studied the effects of diet on metabolism, body weight and risk for chronic disease – with a special focus on low glycemic index, low carbohydrate and ketogenic diets. He has made major contributions to development of the Carbohydrate-Insulin Model, a physiological perspective on the obesity pandemic. Described as an “obesity warrior” by Time Magazine, Dr. Ludwig has fought for fundamental policy changes to improve the food environment. He has been Principal Investigator on numerous grants from the National Institutes of Health and philanthropic organizations totaling over $50 million and has published over 200 scientific articles. Dr. Ludwig was a Contributing Writer at JAMA for 10 years and presently serves as an editor for American Journal of Clinical Nutrition. He appears frequently in national media, including New York Times, NPR, ABC, NBC, CBS and CNN. Dr. Ludwig has written 3 books for the public, including the #1 New York Times bestseller Always, Hungry? Conquer Cravings, Retrain your Fat Cells, and Lose Weight Permanently.  

Lack of food or too much of the wrong kind of food can create a wealth of physical and mental health problems. Making matters even worse, society often blames individuals for making the wrong choices. But data shows us that diet related ill health goes hand in hand with inequality and poverty and occurs at disproportionately higher rates for communities of color. In this episode, we talk with Dr. Ben Danielson, a pediatrician with the University of Washington, about the parallels between food banking and healthcare. And, how both systems manage social problems and could benefit from addressing food insecurity systemically at the root causes level.     Host: Christina Wong, Northwest Harvest   Guest: Ben Danielson, University of Washington   Producer: Deborah Hill, Duke World Food Policy Center   Interview Summary   We know the benefits of healthy food and we see ongoing impacts on child health outcomes as a result of food insecurity and family reliance on food charity. In your opinion, what are the key issues that health and food providers need to address?   Well, I think this is an opportunity for us to be a little bit reflective and to step back. I want to ask us all: what is the narrative that we've created around food and food charity? What is the story that we're telling ourselves? Is it a narrative or a story about heroes who are philanthropically giving of themselves to put food in front of folks and the poor destitute who are somehow just waiting for this kind of charity to show up? Are we disempowering some populations and creating super powers in others? What is the story that we're telling ourselves about food charity? And if we think about that, what is the environment of food and the food and health system that we're talking about in that narrative?   So I wonder about charity because sometimes in our society, we allow folks with great resource to make their choices about charity in order to help support other parts of our society. When in fact, sometimes those great resources are attained because of avoiding a need to pay taxes, avoiding other parts of supporting our society's infrastructure. And we sort of pulled away one set of resources and then allowed a certain number of people to provide a small amount of resource in a separate way. And I feel like maybe that is a narrative, a story of heroes doing something heroic instead of a story of a society that everybody cares about each other, everybody has strengths, everybody is making sure that everyone else around them is strong and healthy because that's the way we all get so much better. So I wonder about this idea about charitable deferral, the avoidance of supporting infrastructure by providing a trickle of resources to other spaces. I wonder about that infrastructure and the wealthiest of wealthy nations shouldn't we have some basic idea of the components that we should all be should all have a right to, should all be entitled to make sure that we don't have to worry about? Because I will tell you beyond the caloric issues of food, the worry about food, the preoccupation with wondering about food is just as detrimental to the mind and the body and the soul of folks who deal with food insecurity every day. I wonder about this as a symbolic representation of poverty by creating this space where food is delivered in sometimes undignifying ways to folks whose food security is weak. How we create a strong picture of folks perhaps BIPOC (Black, Indigenous, people of color), in different communities being subjugated, being marginalized. And that marginalization kind of being represented by this delivery of food in this way that we do it. I wonder about what we are accountable to, each of us.   I see in my role as a pediatrician, I watch these amazing kids every day. These incredible kids with just a look in their eye that tells you they can change the world for the better, they have all the skills and tools and hopes and dreams and potential to do something incredible. And all they need from us is the right space, the right environment, the right cultivation to allow incredible things to happen. I wonder how our narrative could be about celebration and optimism and strength and brilliance. And how we are all so much better when every one of us including the people that we never meet have everything they need to do their best.   There has to be a better way. From what you're seeing from your experiences and what I'm seeing working at a food bank, that there's a real power imbalance that is being perpetuated by the system. A system that's designed to help people, but we're maybe not helping people live to their fullest potential. And I feel like this pandemic has really shed a lot of light on those inequities. During the COVID crisis, food bank providers focused on simply getting food to people. But it has also got us thinking about upstream solutions, such as enacting the right to food in Washington and in other states. What has the COVID crisis revealed for you?   The COVID crisis for me has revealed the need for us to be willing to think with a slightly deeper sense of complexity than the simplicity that we've sought in the past around some of our deepest social problems. It's so important for us to think both in the moment and to think upstream. To think about the intervention and the prevention. About the spaces where people need us in these moments, and the spaces in which our investment in ourselves and in others creates a world where that need does not perpetuate.   I hope that isn't too vague and sort of up in the sky, but I do think this pandemic has brought out the many ways in which our social and cultural infrastructure has been designed to subjugate people. To hold people down even as we're doing symbolic acts to sometimes be helpful to people. That the greater system is designed to make sure that a poor person in this country knows that they are poor. For the person who has been poor and their parent has been poor, and the grandparent has been poor, that poverty is more likely to persist because of the way we have designed society. This pandemic has reminded us that we have systems in place, and I must say with shame, especially our healthcare system and our public health system, that are not designed to serve those who are the most harmed by illness, the most harmed by chronic disease, the most harmed by economic deprivation. We have systems that are perpetuating exactly what we've seen during this pandemic and have accentuated the differences in this society between those who access to much material resource and those who have been deprived over generations that kind of access.   This is the revealing. The COVID pandemic is not a new set of elements, although it is newly deadly to black and brown communities in ways that it is not as deadly to others. But it is more importantly the great revealer of the many ways in which our society has been infiltratively practicing a disregard and an indignity toward many other people in our society.   So then let's talk about solutions. What possibilities do you see for improving some of the conditions that you've been describing?   I think that we need to reframe our work around making sure that when we are doing things to support those around us, that promoting dignity is one of the most important components of that. I guess you can tell from my conversation, I think we all have a bit of reckoning to do. Each of us has our own personal reckoning to do that has to come with a deep reflection about our role and our place in society. What is the story we're telling ourselves about those that we see as other from us, not like us, not sharing our particular set of values, life experiences, or even melanin, how do we change that story? Because when you really look around you, what you see is an incredible potential. What is getting in the way? I think part of it is the way that we frame the things that we call problems in our society. Because out of those problems, there is so much more opportunity, there is so much more possibility. Just from a basic resource perspective, we are in countries that have amazing wealth and the potential to make sure that not a single person in those countries needs to be suffering. Not just the suffering of calorie deprivation, but the suffering of indignity. What would happen if when we designed programs to support each other? Based on the brilliance that we know that these communities around us possess, based on the desire that we all feel to make sure that we are treated with dignity and respect, how should we design these programs? We know that everybody should have a right to really making sure that they have the kinds of nutrients that allow their brains and their bodies to function at their best potential level. What should we be making sure every one of us has? It's ironic to me that as we make decisions that harm other people around us, they ultimately harm all of us. And until we make that fabric, that interwoven connection between us and the person nearest and far from us, we're not going to make better decisions, until we decide that there's greater joy and potential and possibility out there than there is deficit or lack or loss, then we're not going to make strong choices based on that optimism.

Today's podcast is part of our Regenerative Agriculture series of podcasts. We're talking with agroecologist Dr. Jonathan Lundgren, CEO for Blue Dasher Farm in South Dakota, and also founder and director of the ECDYSIS Foundation. Dr. Lundgren connects the worlds of science and agriculture, and his working regenerative farm is also a scientific research hub. And he has a humble goal to foster a revolution in our food system, and demonstrate feasibility and sustainability of regenerative agriculture. Interview Summary   So Blue Dasher Farm in South Dakota sounds like a fascinating place. Can you tell our listeners a little bit about it?   Blue Dasher Farm is an operating demonstration farm and regenerative ag, located here in the middle of kind of nowhere, South Dakota. We wanted to be on the front lines of where change needs to happen, and we're at this great interchange here between corn, soybean, row crop ground, as well as rangeland systems, but also this is where a lot of the nation's honeybees ended up being too. We've got this kind of trifecta of crop lands, orchards, rangelands and honeybees. What this is intended to do is not only be a regenerative farm and integrated into a farming community, but also be a training ground for the next generation of scientists in practicing hands-on, get your fingers dirty agriculture, and that's really important. That firsthand perspective really shapes the questions that we ask, and how we ask them in science.   Tell us about what's grown on the farm. Is it animal agriculture, plant-based agriculture, both?   It's an integrated system. You know, it's not a very large farm with 53 acres, and half of that is actually a native, unbroken prairie that's one of the finest that I've seen. We also have a lot of wetlands that are integrated into this matrix here too. We have sheep. Our biggest moneymaker is honey. We have 200 beehives this year. We have an orchard, chickens, an egg production, as well as a number of other poultry products. We raised a couple of pigs this last year. We have some annual and perennial crops that we harvest for seed, especially native grasses, and things like that, and it's all fused into one big farm that presents us with consistent, unpredicted hurdles and opportunities.   So the concept of integration here is really important. Sounds like each of these pieces you've mentioned, and there are a lot of them, work together, and that if anything were just taken out and done by itself, it wouldn't work as well as having all these things together, and that's the overall concept here, isn't it?   That is absolutely correct. The integrated system is intended to increase the resilience of the farm, but also provide stacking of enterprises that increases the likelihood of success.   Our listeners will vary, because people come from lots of different backgrounds, and some will know a lot about agriculture, but others less so. Can you give us an example or two of something on the farm where the integration really helps?   We have annual crop ground that we are working on right now. We don't spray. We're not certified organic, but we don't spray anything, and we also don't till, and those are two really important premises of regenerative Ag, if you ask me. And so we use our sheep as ways of managing vegetation out there, and then we work with the land, and so in the case that we don't end up getting, like this last year, the drought was horrible in South Dakota. We ended up not getting an annual crop to establish in there, but perennial plants, the prairie ended up coming in, and so off of that piece of ground, instead of an annual crop, we took meat from the sheep, and honey from our bees.   That's a fascinating example. So the no-till is an interesting concept, and I'd like you to describe a little bit more about that. I know that a goal of yours is develop and evaluate ecologically-based test and farm management solutions, and you do this in order to reduce disturbance. I'm assuming that has to do with a no-till, but I'm not entirely sure, and then that you want to increase biodiversity in crop and livestock production. Can you explain this concept of disturbance?   Pests are never the problem within a food system, right? Pests are always a symptom. The pests are trying to correct what we have monkeyed up from a natural system. They're trying to reset the balance in the biological community, and until you solve the underlying issues with that system, you're going to continue to battle pests, and you're going to have to spend more and more money on input costs like pesticides. So what we determined is what the underlying problem is, is a lack of diversity, lack of life on the farm, and too much disturbance, and disturbance comes in many ways. Tillage is a disturbance, agrochemical use is a disturbance, and so when you start to eliminate that disturbance, you find that life ends up doing a lot of the things that we've been trying to replace with technology. Regenerative farming is much more knowledge-intensive, and less technology-intensive.   So what's the problem with tilling?   Tillage is one of the worst things that you can do to your farm or garden. What happens when you do that is number one, you break down organic matter in the soil, which is the soil's fertility, and you disrupt the balance of nutrients within that soil. The only way that you can replace that organic matter is with life, right? Be it worms, or insects, or microbes, or fungi, that's where the soil's fertility ends up coming from. And the one-two punch with tillage is that not only does it disturb the nutrient balance of the soil, but it also kills most of the life from the soil, and so it removes your ability to recover. We end up seeing a lot of farmers, you know, they want to do the right thing, and they're faced with this conundrum, do I spray or do I till? And boy, I think I'd pick, and I don't like either of those options, and we don't use either of those options on our farm here at Blue Dasher, but I would pick spraying over tilling any day of the week.   Thanks for that description. So let's turn our attention for a moment to science, because you were trained as a scientist, and you've done lots of science yourself over the years, and you support science on your farm. So with your permission, I'd like to read a little quotation from your website, because I think it captures your approach to science, and then like to talk about a little bit. So here's the quote,   "Scientists have to become farmers to increase the relevance and credibility of their research. Scientists also have to become part of the farming community, and farmers need to be intimately involved in producing scientific research. The metrics that scientists assess their success by have to be reinvisioned to incorporate outcomes that farmers care about."   So explain a little bit about why science is so important, and maybe you could give us some examples of some science that's been done on the farm, or even some things that might be underway.   Regenerative agriculture science is essential. Stories are really important, right? Anecdotal examples of, "This farmer did this, and it worked super well, or didn't work at all." Those are really, really important foundations for science, but until we replicate it, and use consistent methods for measuring the outcomes of these different systems, those are anecdotes, right? And so science is going to be essential for us to take and increase the credibility of this regenerative movement to show that it always works, where it works, where it doesn't work, what aspects of it are driving the success of those farmers, and there really isn't a whole lot of primary data that's being generated on regenerative farming right now, and we saw that niche, and decided we needed to be a part of that.   Just to give our audience a sense of what kind of outcomes might be important here, let's just say somebody is doing a study where they're randomizing a hundred acres here, a hundred acres there, using a regenerative versus traditional ag. What sort of outcomes would one be looking for? What are the most important things that people doing research on regenerative agriculture need to show?   Regenerative food systems increase soil health, and improve biodiversity, while producing nutritious food profitably, and so outcomes that need to be measured in these systems fall within those general four categories, soil health, being carbon sequestration, water balance in the soil, micronutrient availability, biodiversity being life, be it microbial life, or insects, or worms, or plants, birds, all would fall into that category, nutrient density, nutritious food yields. We actually have to feed the planet. We've lost 40% of the nutrient value of our food over the last several decades through our farming practices and destruction of our natural resource base. We need to restore that. Food isn't as nutritious as it used to be, and then finally profit. All of this as well and good, but if the farm goes out of business in the interim, then it didn't work. We're showing these on actual farming operations all over North America right now. We have boots on the ground science that is generating the data that shows that this does work in all of the systems that we've examined so far.   You know, Jonathan, with these podcasts, I always have a series of questions that we prepare in advance, but you've stimulated so many interesting ideas, I'm going off-script like crazy. So there are a couple of things I really wanted to dive into here. When you were mentioning outcomes, I assume one outcome is how many external inputs are needed, like pesticides, and herbicides, and fertilizers, and things like that, and I'm assuming that that's important for a number of reasons. I'm imagining profitability as one, because if you can produce crops without having to buy those things, you're able to be more profitable. But I'm assuming these things are really important for the environment as well. Is that true?   So with regenerative farming, it ends up being a win-win for just about everybody in the situation. By improving the resilience of their operation, and the profitability of the operation, the farmer wins, right? By reducing the environmental exposure to agrochemicals, their families win, communities win, conservationists win. We find that increasing the nutrition of food, suddenly the medical field wins, society wins. We can use this to combat many planetary-scale problems. One estimate is that by changing to regenerative grazing lands across the U.S., we can largely offset, if not completely replace most of our carbon emissions, while producing healthier beef, and making healthier rural communities. That makes a heck of a lot of sense.   Do you think there would ever be a time when instead of measuring productivity as yield per acre, number of bushels, let's say, and people might change that to think about nutrition per acre?   We have found that corn farmers in our area get prizes if they are the top-yielding corn producer, right? And we found in one of our studies, the first one that was published that used regenerative Ag, and compared those two systems from a primary literature standpoint showed that yields were actually not correlated with profitability. You know what was correlated with the profitability of the farm was how much soil organic matter they had generated on their farm, yeah. So I think that that's going to be a really important metric, and, you know, as these soils start healing, the nutrition of food comes from the soil. It's not from a jug that the farmer is putting on the plants, right? It comes from the soil itself.   You know, I've often thought in this context about whether consumer pull for certain types of products might help drive this market. So for example, let's say you have two carrot farmers, and one is using conventional methods. The other uses a different set of methods along the lines of what you're talking about, and that farmer produces a more nutritious carrot. Could consumers be attracted to the carrots with the most nutrition? Might, is there any talk about this in the farming community?   Oh, absolutely, farm to table and farm to school programs are really important. I think we talk about labels. We talk about all kinds of ways of increasing the value of regenerative. Regenerative has to be cost-competitive with conventional if it's going to be successful, and it is. In every system that we've studied it is. It's cost-superior. These producers are more profitable, and that doesn't necessarily have to be associated with a premium. At the end of the day, what is incorruptible is consumers knowing their farmer, and that is the answer to so many of these issues within our food communities right now is people starting to learn who their farmers are, and that relationship-building, and that trust, and that's going to put a lot of value on a food item.   I can second that. As a person involved in this field, and a consumer, like everybody else, that does really make a difference. So my colleagues and I at the World Food Policy Center have spent a fair amount of time on farms and meeting farmers, and I really want their products, because I know who they are, and those personal connections mean everything. So I totally agree with what you said. It's interesting to hear that that's part of your perspective as well. Speaking of honey, let's go back to the bees for a minute. You mentioned this early on in the podcast. Why are honeybees so important?   Honeybees are a character, at the end of the day, and what we're trying to show is the massive extinction event that the planet is currently facing right now. We are undergoing a massive evolutionary experiment, and we're losing species at a rate that the planet has never experienced before. Honeybees are a character that people understand, and they see the benefits, and even if they've been stung a few times, they still love these little insects, right? The honeybees are dying at a really rapid clip, and the reason that they are is because they're such a good bellwether for what's going on in the environment. I mean, they forage for up to five miles from their nest, or their colony, their hive. They sample multiple plant species, numerous, if not hundreds of species of plants, and they pull all of the chemistries that are out there in the environment, and bring it back to the nest, and most of agrochemicals are actually lipophilic in that they like fat. Guess what their hive is made out of? Wax. And so they end up aggregating a lot of agrochemicals. Those agrochemicals make them sick, and stressed, and diseases come in, and pests come in, and wipe them out. But on the flip side of that, regenerative systems provide a tremendous opportunity for conserving life, and we've been working on trying to demonstrate that with the honeybees and tell that story.   Do I recall right, you said you have 200 hives? Wow, so how much honey can you produce from that number of hives?   Well, this year, not much at all, but last year, I think we got a thousand pounds, or something like that. You know, people that go to the grocery store, and buy honey at the grocery store, they don't know what honey tastes like. That's not real honey. A lot of that is actually adulterated rice sugar from Asia that they ended up circumventing U.S. trade restrictions on, and most people tell me, "I don't like honey, but I really like your honey, John." And I'm like, "Well, that's because it's made from prairie flowers, it's got no additives whatsoever, and it comes out with this breadth of flavor that most people have never experienced before."   It sounds so good. I want some right now. So let me ask you one final question. This often comes up in the context of discussions of regenerative agriculture, and has to do with how scalable it is. People might say that, okay, the results from regenerative agriculture are impressive, but you still need the feed the world, and can that model be used on a big enough scale to accomplish feeding the world? So how do you respond to that?   If you want to feed the world, grow food is the first step in the process, and right now we have about what is it, 176 million acres in the continental U.S. that's devoted to corn and soybeans that we really don't eat? And so if you want to feed the world, let's start there. Can regenerative farming feed the world? We have shown that yields are equivalent in regenerative systems, if not superior, and the caloric content of products that are generated off of a regenerative farm versus a monocrop of a conventional farm are pretty superior, actually. So we really need to be measuring actual food production, things that humans are eating directly, and the efficiency of that system, as well as how stacking enterprises increases the resilience and efficiency of a farm.   You mentioned just now that there are vast amounts of acreage that are devoted to corn and soybeans that we don't eat. What do you mean we don't eat them?   Well, when's the last time you went down and grabbed a handful of corn, yellow number five, and took a bite? We end up burning it in our cars. 40% goes into ethanol production. We end up putting another 40, 50% of that into cattle that would rather be eating grass, and so when we hear arguments against beef production because of the methane production that's ended up being produced there, that's not an artifact of the cows. That's an artifact of poor management of the cows, and if you put them on grass, and manage them correctly, cattle production is a carbon sink. It's not a source.   Bio   Dr. Lundgren is an agroecologist, Director ECDYSIS Foundation, and CEO for Blue Dasher Farm. Lundgren's research and education programs are helping applied science evolve in ways that foster the movement in regenerative agriculture. He received his PhD in Entomology from the University of Illinois in 2004, and was a top scientist with USDA-ARS for 11 years. Lundgren received the Presidential Early Career Award for Science and Engineering by the White House. Lundgren has served as an advisor for national grant panels and regulatory agencies on pesticide and GM crop risk assessments. Lundgren has written 129 peer-reviewed journal articles, several book chapters, authored the book “Relationships of Natural Enemies and Non-prey Foods”, and has received more than $6 million in grants. He has trained 5 post-docs and 15 graduate students from around the world. One of his priorities is to re-envision how science is conducted to help fuel a revolution in regenerative agriculture. He regularly interacts with the public and farmers around the world regarding ecologically intensive farming and how diversity fuels the resilience and productivity of an agroecosystem and rural communities.   

So what does it mean for something to be considered organic, or to be considered regenerative or sustainably produced? Defining these concepts in agriculture production and in food labeling is complicated, but very important. So government defines and oversees certain terms, while other terms are generally overseen by producers, by industry experts, or even by non-governmental organizations. The politics and governance structures of labeling can be very important in how sustainably produced goods are made and marketed. In today's podcast, we'll speak with Dr. Samantha Mosier, political scientist on the faculty of East Carolina University, as part of our Regenerative Agriculture podcast series.     Interview Summary   So let's begin with this question. Why do you believe there's so much interest in alternative agriculture production?   So agriculture has been changing. We only have the concept of alternative agriculture because we went through a really rapid industrialization and mechanization of agricultural practices in the past 100 years or so. So this idea of alternative agriculture sprung out of a critique of agricultural production norms that were industrialized, that were causing environmental harm, like declining soil quality, which led to such events as the Dust Bowl. Today, the shift and interest into alternative agriculture stems from some pretty hard lessons learned about modern production, where we are seeing soil quality continuing to decline. Yields are also declining, and we want to be able to feed the world and our population. And so these practices that were once advocated are not necessarily working as they should. For producers, there's also some profit to be made in a number of markets if you're able to shift your production and get that certification in that sustainable market, or at least adhere to the norms of a particular production concept enough to make that claim.   You know, in some ways, what I hear you saying is that from a consumer point of view, many more people are becoming interested in the story of their food, where it came from, how it was produced, how animals were treated, what the labor situation was like, etc. And my perspective on this, and tell me if I'm right, is that this trend seems to be growing exponentially. There was a time not too long ago when people didn't think about this or they didn't know much about it, and now, boy, there's whole generations of people care about this an awful lot. And it shows up in the way they make purchasing decisions and where they do their shopping and things. But is that right? Do you think that this trend is really increasing?   Yes, rapidly increasing. So from a consumer perspective, you can look across a range of these alternative food markets, anything from organic, non-GMO, fair trade, and you'll see that sales across the board have exponentially increased in the past 10 to 20 years. So where there wasn't so much of an interest or spending habit in these categories, all of a sudden it just went through the roof. And so a lot of this does come from deferring or changing consumer behavior and expectations. We know that younger consumers in particular are concerned about climate change and the environment. So they're more likely to be environmental consumers to the degree that they can afford to do so because it is more costly often to buy these products. But there's also this whole component that these types of foods have also become more mainstream and readily available. And so organic foods 30, 40 years ago, were really difficult to find if you were to go into a typical grocery store. Today, you can find organic, fair trade, non-GMO products in Walmart, and Target, and Kroger. Even the Dollar Tree or Dollar General stores, you can find products that are labeled as sustainable in some capacity. So they're more readily as well.   Thanks for those comments. And I think in addition to those things, there are other signs like number of people shopping at farmer's markets, farm-to-school programs, farm-to-childcare programs, and you can go on and on, the list is pretty long. And I think it's pretty exciting. You know, I was thinking about this myself the other day. Not too far from where I live in Durham, North Carolina, there's a state farmer's market in Raleigh, which is just an absolutely wonderful, massive farmer's market. And when I was walking through the other day, I saw a farmer selling honey. And I thought, you know, this farmer appealed to me. I hadn't met him, I hadn't spoken to him, but I thought, he probably works really hard and he probably cares about what he does. And that really appealed to me. And I have plenty of honey at home, so I didn't need to buy any, but I wanted to buy it anyway. There's just something wonderful about that kind of connection that exists. It seems to me more people are caring about the farmers in this picture too. Do you think that's correct?   It depends on the consumer. I think in some cases, the ones that may be more informed and maybe go to farmer's markets, they're going to be more interested in where the food comes from. But there is a segment of consumers out there that they'll go off of the certification label because it's a little bit easier. Maybe they're crunched for time, they have kids, their job's demanding. But overall, we still like the idea that our food comes from a wholesome place.   Two terms that we've discussed, organic and regenerative, let's talk about how these two things are different from one another. Most people are familiar with the term organic, if not knowing how it's defined, but regenerative is newer on the scene.   Organic is specifically defined by government regulations and what a certification program dictates as organic. It's a concept that is really grounded in a consumer perspective because the label creates a singular four-based minimum standard for what it means to be organic. Not all producers actually agree with the current standards for what it means to be organic and organic production. There are a number of them that are interested in going above and beyond organic standards that are currently set. And this includes concerns about animal welfare. So how we're treating cattle and chickens in our production systems that are organic.   There are also a lot of concerns centered around hydroponic production systems being considered organic. Hydroponic is a type of production system that can't improve soil quality because there is no soil. And this is where regenerative discussions come from. The modern regenerative movement is based out of a movement from organic production and their critiques of our current system. The Rodale Institute about 30 or 40 years ago, specifically talked about regenerative organic production. The more modern concept of regenerative is a critique about the broader concept of a sustainable food system, and the need to do more than just be sustainable. And it really engages quite a bit of concessions about soil health. The problem with, I guess, modern regenerative agriculture is that it's not neatly defined. There's a heavy emphasis again on that soil quality and regeneration concerns, but there's no universal definition. It's not universally regulated, government's not involved with it. And so the most you can really hope for when you're seeing this term currently is producers acting in good faith when they're advertising their goods as being regenerative, and they can go get certified for it now. But again, you'd have to look into the details as to what that certification actually entails.   Let's talk about the role of government in this process a little bit more. So how do you think the government has impacted the way agriculture production is occurring and market activity? And do you think there's a benefit to having these claims certified or regulated?   So government does play a role. It legitimizes the market to some extent. It protects the term that's being used. It provides, you know, a standard, a reference point to where we can all say this is organic, but there's some challenges with that of course. So anytime you involve government that means you're going to take away certain freedoms to interpret the concept the way you may want to as a producer. And so when we start getting into certification programs, we know for example, that third-party certification systems for labels and production systems are a Gold Standard. We know this, but the challenge becomes is that when you start certifying and you start regulating these markets, is that, well, the cons are consumers could still misinterpret the term because what the USDA, for example, defines as organic may not be what I, as a consumer, believe organic to be. And so kind of this image of a small happy farm with a dog doesn't necessarily exist. Organic production, some have claimed, is really highly mechanized and it's became large scale. And this is part of that challenge with the one-size-fits-all standard. And the baseline standard is, all of the sudden there's a market being developed, and producers are going to adapt to that and enter it. And so a lot of people, at least with organic certification, have claimed that it became corporatized. It's industrialized production, just in a slightly different form. But the pros are, if you're looking for a guarantee, say you're one of those consumers that's really short on time and can't go to the farmer's market, well, it helps minimize false claims. You have a general idea of what you're actually buying. So it's a unified messaging signal. And you know, the semantics of course, is debatable about what it means. And for producers, this means they can receive a premium for the products they're producing.   Has the fact that organic production in some cases is highly industrialized, has that led to greater yields? Has that brought down price?   I think it depends on who you ask. I know the pandemic has thrown some concerns in terms of sourcing and other certain certification systems that are dealing with the reckoning of ending their contracts with small scale farmers in favor of larger scale farmers. But overall, organic has perhaps gotten maybe a bit cheaper because it's more readily accessible, but there are challenges with some companies with being able to source enough organic material to meet the demand. And so typically, you do still pay a little bit more for organic or sustainably produced, however defined, goods, but the price will always be a little bit higher than conventionally produced materials and products.   For consumers who are interested in purchasing these alternatively produced foods, what kind of challenges do they face out there in the market?   Well, they probably need to figure out what matters to them the most, and they need to do their homework about what a label means. So certified claims do come with some particular benefits. You can research very easily what that may mean, and you might not understand all the technical and scientific information, but kind of understanding the basis of what you're looking for in an item. So, as an example, you mentioned looking for honey. I was shopping for toddler food, and I was looking on the toddler can of food, and it had USDA Organic Certification Seal. And then, right next to it, it was also advertised with a label saying it was non-GMO. The thing is, is if you know anything about USDA Organic, it doesn't contain genetically modified ingredients to begin with. But as a consumer, which we have more or less-informed consumers, they may not know that USDA Organic means it's non-genetically modified. So these producers, the seller of goods, also have to advertise other benefits of the product because that consumer is not aware. So it's educating yourself and understanding what you're buying and not getting duped by just marketing claims.   Bio:   Samantha Mosier is an associate professor of political science and part of the Master of Public Administration program faculty at East Carolina University. Her research focuses on sustainable agriculture, food labeling, and local sustainability and resilience initiatives. Mosier is author of Creating Organic Standards in U.S. States: The Diffusion of State Organic Food and Agriculture Legislation and co-author of Performance Measurement in Sustainability Programs: Lessons from American Cities. Her work has also appeared in Environment and Planning C, Environmental Management, Food Policy, and Review of Policy Research. Prior to joining the faculty at ECU, Mosier was an assistant professor at Missouri State University and served on the University of Missouri Extension Council in Greene County, MO.     

In this episode, we'll explore the connection between hunger and health. Welcome to Rights Not Charity. This podcast series is about a big idea, ensuring everyone has enough food, not as a charitable gift, but as a fundamental human right. My name is Christina Wong and I'm the director of Public Policy and Advocacy at Northwest Harvest, a food justice organization and statewide food bank based in Seattle, Washington. Our guest today is Dr. Ben Danielson, a pediatrician with the University of Washington.   Host: Christina Wong, Northwest Harvest   Guest: Ben Danielson, University of Washington   Producer: Deborah Hill, Duke World Food Policy Center   Interview Summary   So my first question for you is we all know that access to good food is a vital component of physical and mental health. Can you help us understand the links between diet and food access and how it affects health?   Well, I guess we have to just start with the basics. Not having enough food, or the right kind of nutrition, at least, leads to serious and often deadly health consequences for so many people across this country and other countries as well. When you don't have enough calories that just means you don't have the kind of energy you need for work. It means that if you're trying to learn, you don't have the potential to be able to learn effectively. If you don't have enough calories, you can't play, and you don't have life fulfilling activities that are important to you. But it's not just about not having quite enough calories, it's also about issues of making sure you have access to the healthiest foods and the right micronutrients.   There are ways in which hunger can be all around you, and you might not realize it, because people might not look like they are underweight or starving. In fact, a lot of people who have nutritional deficits can be overweight and malnourished at the same time. This is the paradox and the painful reality of not having enough food for too many people in North America and Europe. These problems are really linked to the way we think of economic inequality. When a parent is low income, they might struggle to afford fruits and vegetables, and they might go for the higher calorie foods per dollar. But that higher calorie content per dollar may be lower on the nutritional scale. It may not be the right kind of micronutrients. It could lead to someone actually feeling full, but not having a fulfilling diet. This means that again, young people, old people, children are filling their bodies with calories, but not with healthy foods.   If we are part of a nation, part of a continent, part of a globe that cares about making sure that each person can fulfill their potential in the way that they're supposed to, it really needs to be time for us to rethink the way we talk about food, about the right to food, about access to food. Because it's more than just nutrients. It's not enough for a food company, say, to add a few fortifications to their cereal. It's not enough for a particular product to be enhanced with certain micronutrients. What we need to be doing is really talking about food differently, and talking about body size, and body shape, and body weight differently. We need to have new conversations about access to healthy food, the rights of all of us to get food, the chance for young people to grow and fulfill their biggest dreams because they have healthy diets. And, the obligation that we all have to each other to making sure that we can live our fullest lives.   I just love everything about your answer. I feel like I can really hear the care that you have for your patients in that answer. And speaking of which that paradox about caloric intake, when you're hungry, that leads me to my next question, which is when it comes to food insecurity and particularly the obesity pandemic, people tend to focus on individual responsibility. We often hear this framed as an issue about people making the wrong choices when it comes to their dietary health. So what is the role of personal choice in the food and health relationship?   I think that's a really good question. It taps into some of the deeper emotions we might have as a society around issues of food, and weight, and body shape. And it's important, I think, for us to break down some of those concepts and get into this conversation more honestly and more authentically with each other. One thought that comes to mind for me around this topic is we don't often talk about access to choices. So we find sometimes that we're judging people for the way they make choices about food, about other purchases, about other options they make in their lives, when we don't fully understand what choices they actually have and what choices they don't have. Sometimes it's more about the access to choice that drives choices, even unhealthy ones, than it is about how we make personal decisions. And I think we need to step back from that moment of choice and look around about the environment of choice. About the environment of opportunity, and of self agency and of decision making. And really understand how we as a society create options for folks that allow them to really make their fullest lives realized and make their best choices in those moments.   Do you have any examples from your medical experience to clarify that for our audience?   As a pediatrician, I work in a mostly low-income, really culturally rich and diverse community. The relationship of food to reaffirming the connectedness between people in a world and in a society that is often trying to rip people's connections apart makes for the need, the necessity of actually bringing food into spaces in a way that is reaffirming, reaffirming and demonstrative in powerful ways. That is an important cultural choice as well. And having the opportunity to gather around food, to celebrate with food, to say there is love in this space and we are naming it and claiming it partly by celebrating with food. That makes the idea of food, the choices around food, a little bit different than what calories are going into your body, what is the healthiest versus the unhealthy choice, what is going to be the right micronutrient in this moment. And it brings us into a conversation about food as a celebration, as healing in its emotional form, as part of our memory that is passed on through generations. That is actually important. When that is part of broader society, a broader place of opportunity, then it becomes less important about what happens in those moments of choosing, and becomes much more important about how else we allow people to remember their culture, to know their history, to share their stories, and to be part of generations upon generations, building resources and strength together. That sounds, I know, challenging for some people. Because we want to just focus on this moment of whether or not you picked the vegetable or not, when you had a few different foods to select. But we have to step back from that. We have to think about what is going on that allows this particular food to be meaningful to you, to be a strong memory to you, to make you fight back against maybe the way society is trying to erase your identity.

As many as 13 million children in the United States live in food insecure homes, meaning that these households don't have enough food for every family member to lead a healthy life. Hunger is a problem that most often affects children from low-income families. And today we're going to discuss the Child Tax Credit aimed at helping low-income families and the historic increases in the credit made through the American Rescue Plan in 2021. Our guest today is Billy Shore, the founder and executive chair of Share Our Strength, a nonprofit working to solve problems of hunger and poverty, both in the United States and around the world. Share Our Strength is also the parent organization for the well-known No Kid Hungry campaign, the national policy, advocacy, outreach, and research effort to improve childhood nutrition, support school meals, and provide resources to schools, food banks, and community groups working to end hunger.   Interview Summary   So the child tax credit has been around for years, but this year there was some significant, albeit temporary, changes that made it a powerful tool in fighting poverty. Could you quickly walk our listeners through what these changes have been?   The most important change for The Child Tax Credit is that Congress and the Biden administration made it fully refundable - which is a way of saying that even if you don't earn enough money to pay taxes, you still get a check from the government somewhere between $3000.00 and $3360.00 per child. And one of the ironies of the Child Tax Credit in the past has been that many of the families who need it the most might be the least likely to get it if they weren't earning enough to pay taxes or file taxes. Now there's a portal that's been developed with the Internal Revenue Service and a nonprofit called Code for America that we worked very closely with, where even if you haven't earned any money, you can file for the Child Tax Credit. And you can use those funds for food, for education supplies, for healthcare, for really whatever you need it for, for your kids. It's estimated that it can bring 5 million children above the poverty line, which would really be absolutely transformational.   That's a remarkable impact this could have. So just out of curiosity, are there programs or means for letting people who might be eligible for this benefit know that it exists providing help in using the portal and doing things like that?   That's a great question because there's an all out effort beginning right now, not just to raise awareness of the Child Tax Credit, because a lot of families are not aware of this new benefit, but to also make it more accessible. Many families are going to need technical assistance as to how to access the portal called Get Child Tax Credit, getctc.org. And then when they're on the site, they might need assistance then as well. So there's a major effort. Think of this almost as like a political campaign. One of the things that Share Our Strength is doing right now as a pilot is building out a field operation in two states to see how this would go in Mississippi and in Maine. And we've got regional directors and field staff. And just as you would have a staff on the ground to register people to vote and to make sure they get to the polls, we've got a staff on the ground that is going to make sure people are aware of the tax credit. They get to their Community Centers or the sites or the volunteer tax assistance sites that they need to get to so that they could actually file. And then as we learn from those two pilots, we'll spread that into all 50 states.   Given that you and your organization are working to address food insecurity, why put efforts behind legislation that would address poverty rather than just food insecurity itself, providing more food for people or more benefits that provide food? Why work on poverty overall?   You know, one of the things that we've learned over the last 35 years of doing this work, and I would say, honestly, it took us too long to learn it, but we've really come to the conclusion that it takes more than food to fight hunger. And so, you know, we all have a reflex when we think about people being hungry, how do we get them food? And we think in terms of emergency food assistance and food banks and soup kitchens and programs like the school meals programs or the SNAP food stamp program, but to really end hunger in a sustainable way, it does take more than food to fight hunger.   Families have to have the financial stability. You know, when you think about hunger as a symptom of a set of deeper problems, in some ways it's a problem in and of itself, but in many ways it's a symptom of deeper problems of poverty and inequity, racism. When you think about all the reasons that families are struggling today, you realize that we've got to do more than just provide food. And so the Child Tax Credit is the first and the largest opportunity that's come along, probably in a generation or more, to really give families the unrestricted resources they need. And one of the things that we've learned just from the July tax credit payments, so just as recently as a few months ago, we found out that 47% of the families who received the tax credit used it to buy food for their families. So we know that the impact is direct. Other families, of course, used it for some of the other things I mentioned, educational supplies, healthcare, that type of thing. But food is going to be one of the biggest allocations that the child tax credit receives.   That makes perfect sense. You mentioned just how many families could be affected by this. Families now living in poverty who would have some benefit from this program. And you've also talked about the issue of how the child tax credit could be important in building equity. Could you speak to that?   As you know, disproportionate numbers of black and Hispanic and Asian American Pacific Islander, indigenous children, experience hunger and the Child Tax Credit has a direct impact. It also has a disproportionate impact, in a positive way, on them. So it would cut poverty by 52% for black children, by 45% for Hispanic children, by 62% for indigenous children. There are of course, a lot of white families, the majority of families who received the Child Tax Credit are likely to be white and many will receive it automatically if they've been filing taxes. But again, often the families that need it the most are going to be the hardest to reach. So we think it'll have a powerful impact in establishing some equity in a sustainable basis, particularly for black and brown kids.   So you mentioned that many families will receive the Child Tax Credit automatically, but there will be several million families who qualify for the tax credit, but may not be signed up. What can they do?   There's a new portal that's been created. It's in English and Spanish. As I mentioned, it's been created by a terrific nonprofit called Code For America. And if you go to http://www.getctc.org or we have a direct portal, http://nokidhungry.org/getctc. CTC  stands for Child Tax Credit. You immediately get to a portal where you could follow the information and get a check sent to you or deposited. So it's really going to take a massive effort to make this happen.   The current law has this Child Tax Credit in place until the end of this year, until December of 2021. Congress is now debating whether to extend it or to make it permanent. I think most practically, politically, it's probably not going to be made permanent as much as we'd like to see that. It'll probably get extended for three to five years. And it will take that amount of time to make sure that all the families that need it become aware of it and get the assistance they need. So we've got to have a long-term view of this, but you know, you and I are having this conversation in mid-September, and there was a headline today in The New York Times. Just to give you a sense of how important something like this can be, front page of The New York Times and many other papers was that as a result of the assistance programs of the last nine months, including the stimulus payments and so forth, 8.5 million Americans were lifted out of poverty. And that's just remarkable. The poverty rate went from 11.8% to 9.1%. The lowest it's been since they've been measuring poverty in this country. So it's just a great proof point that these programs work. That the social safety net, when it's resourced, when it's applied the way it's supposed to be and maintained the way it's supposed to be, the social safety net really has the intended impact. It lifts people out of poverty and that's good for the economy and it's good for all of us.   Thank goodness the program is working like it is and thank goodness people are paying attention. And the article you mentioned is one way to make that more visible. So let's follow up on this last issue you raised, that this is put in place temporarily, and it's only in effect through December. Obviously, it would be great if this were to continue, what do you think needs to happen to make sure that it continues? And what sort of political actions might take place or data could be collected or other things that could be influential in seeing that this continues?   I think the most important thing is going to be for Congress to hear from Americans, that they want this Child Tax Credit to continue. That they're seeing the impact of it in their own families, in their own communities that they want to live in a country that lifts kids out of poverty. We tend not to be as good at that as other industrialized nations. And, you know, Congress of course, is so evenly divided right now. The Senate completely evenly divided. The House, I think speaker Pelosi, can only afford to lose three democratic votes to get this passed. So this is one of those cases where literally every voice counts and letting your member of Congress know that this Child Tax Credit is going to be important in your community is absolutely vital. You know, when people hear about tax credits, sometimes your eyes kind of glaze over. People don't really know a lot about the tax system or necessarily want to be involved with the Internal Revenue Service, with the IRS, and I get that. But this is one of the big positives to come out of it. And if it does become extended, I think it puts it on a path to permanence and imagine being the first generation of Americans to live in a country where we don't have child poverty at record levels. That would be just an incredible legacy for our entire generation.   Bio   Billy Shore is the founder and executive chair of Share Our Strength, the parent organization for the No Kid Hungry campaign. Since founding Share Our Strength in 1984 with his sister Debbie, Billy has led the organization in raising more than $700 million to fight hunger and poverty and has won the support of national leaders in business, government, health, and education, sports and entertainment. Billy is also the chair of Community Wealth Partners, Share Our Strength's for-profit consulting firm which provides strategic consulting to help leaders and communities solve social problems. Before founding Share Our Strength, Billy served on the senatorial and presidential campaign staffs for former U.S. Senator Gary Hart and as chief of staff to former U.S. Senator Robert Kerrey. In 2014, congressional leaders appointed him to the National Commission on Hunger, tasked with finding innovative ways to end hunger in America. He is the author of four books focused on social change, including “Revolution of the Heart” (Riverhead Press, 1995), “The Cathedral Within” (Random House, 1999), “The Light of Conscience” (Random House, 2004) and most recently, “The Imaginations of Unreasonable Men” (Public Affairs, 2010). He also hosts Add Passion and Stir, a weekly podcast that brings together high-profile chefs and change-makers to talk about the central role food plays in social justice.  

Think for a moment about how much influence the food and agriculture industries have over food policy. Too much influence, too little influence, maybe? People look at this in very different ways. One thoughtful voice in this discussion is today's guest, Gary Sacks, a person who has written extensively on corporate influence on food policy. He has considered corporate control of the food system, running the gamut from global brand consolidation to lobbying and direct involvement in policymaking to actual litigation against country governments, seeking to curb corporate influence. He asks a very key question, is it pastime to question the outsize role of food corporations in our lives?   Dr. Gary Sacks is associate professor at the Global Obesity Center at Deakin University in Australia. His research focuses on policies for improving population diets and preventing obesity and he has coauthored international food policy reports, such as the Lancet Commission on Obesity and several reports for the world health organization on obesity prevention.   Interview Summary   Let's start with this question then: what are some of the ways that food companies do influence public health policy in their favor?   We can group those into five strategies. So, the first one is company lobbying of politicians. That's when they meet directly with politicians or they get involved directly in the policy process, like being on government committees that develop policy. The second one is what we call coalition building. That's when companies fund charities, build relationships with professional associations and that's about winning public support and building relationships that makes it hard for governments to regulate. The third category is their influence on research. They might fund research particular topics and they might host scientific conferences and fun prizes and fellowships in the research area. A fourth strategy we've seen is legal strategies. That's when companies might litigate against governments or have influence over trade agreements, which sets the regulatory framework for how markets operate. And the final way is what we call framing the debate. That's through the way industry talks about things in the media and through their communications. It changes the focus to things that favor the industry. They might shift the blame away from their products and promote individual responsibility for health. So, that's how we've grouped the categories and the ways that food industry influence policy.   So interesting to hear you lay this out and it's an issue near and dear to my heart and I'm thinking back to a paper that I wrote with a colleague, Ken Warner, an economist at the University of Michigan in 2009, comparing the behavior of the food companies with the tobacco companies. And it was just as said, if you look at the tobacco industry playbook and then put next to it, a list of the strategies of food companies used back in 2009, it was check, check, check, everything was quite similar. It's interesting to hear an update on that issue. And what appears to have occurred in those years is that some of the same strategies are still being used, but there are even newer ones and that the companies are becoming increasingly sophisticated at doing these things. So, I guess the big question is, what impact do these strategies have and do they actually work?   Well, they do work. Globally, there's really a lack of action to address unhealthy diets. And yes, there are some success stories, some countries have taken some good actions. But on the whole, across the globe, there's not enough happening to address the nutrition issues we face and it's industry's preferred solutions that have the run. Industry likes self-regulation of things like marketing to kids and product reformulation and they prefer the predominant focus to be on education. So, trying to educate people into what's healthy. But the public health evidence shows that those strategies alone aren't enough. We need much stronger government action. And unfortunately, that's severely lacking.   That is very consistent with the way I've seen things too because there are case after case of industry fighting off, needed government actions, stalling thing, planting doubt with respect to the science and taking all these actions that you mentioned that really are having a big impact. And it's not surprising, government generally doesn't invest money in an unwise way. And they're spending, as you said, billions of dollars doing this kind of thing and obviously it's having an impact and I'm glad that you could point out how. So, what can be done about this?   There are a range of strategies that governments and researchers and health organizations can use to limit the influence of industry. A clear one is to limit industry involvement in policy making. And so, when governments are developing policy, they need to keep industry off the table. While there could be a role to consult with industry about how to implement a policy, they need to get out the policy table, leave that to the public health experts and the policymakers. A second way is much clearer disclosure of lobbying activities and things like political donations. Ideally, with some limits on corporate political donations. Some countries have actually really good disclosure laws, but many countries lobbying is not transparent at all. The third way would be independent funding of research, so that researchers don't need to take money from food industries and universities and research institutions to have better conflict of interest policies. And that's just some of the ways, but really, the conflict of interest needs to be front and center of both policymakers, researchers and even media organizations.   Thanks, those are really innovative ideas. And let me talk about one of them in just a little bit more detail. You mentioned that the food industry shouldn't be at the table when these policy decisions are being made. Now, I know the food industry says, well, wait, we're that stakeholder here. And you'd like to have stakeholder involvement when you're making decisions. And also, we happen to know a lot about issues, but they also very often will claim that disclosure is the solution here. As long as we're transparent about who's on these committees and who might have industry ties and things like that, we're okay. Do you think that disclosure is anywhere near a meaningful solution?   No, I don't. I think disclosure is a start, but actual management of conflict of interest and the risks associated with that needs much more than disclosure. So, as I said, if there's a policy getting developed that is really about regulating harmful products, it's a clear conflict of interest to have the makers of those products at the table. And so, stronger steps need to be taken to manage those risks.   That makes sense. So let's talk about the food industry itself. And I know you've thought about the market power that a surprisingly small number of multinational companies can have. Can you tell us a little bit more about that?   The factor that enables companies to have an influence is that they have a huge amount of power. Globally, it's just a handful of multinational food companies that have enormous market power. And that's grown over the last 30 years through things like mergers and acquisitions and marketing and whole range of strategies companies use to ensure they have this tremendous market power. And so, really, if we're thinking about limiting corporate influence, we need ways to reduce the power of these corporations. We may need to consider stronger policies around merger control and trading practices that enable these companies to have the sort of power that means they have influence.   It's interesting to hear that so many companies have become so much bigger over the years and you're right, that those concentrate power in a small number of hands. So, I know you've also thought about the role that investors play in this picture.   Yeah, we've seen recently that large institutional investors, so your big hedge funds and big asset managers, are starting to play an increasing role in shaping corporate behavior. We've seen examples where these large investors push the companies that they invest in to adopt more responsible practices. And so again, I think if you're looking at leavers for change, if more of these investors push companies to adopt globally recommended public health measures and I guess, refrain from lobbying against them in the first instance that could be an important lever for change.   That's a good way to draw this to a close because you're ending on an optimistic note that if the industries aren't showing much willingness to do this kind of thing on their own and it looks like, in fact, they're doing the opposite, investors can have an important role in industry behavior. And it looks like there are more signs of that happening.   We are seeing investors focus on things like the sustainable development goals and really taking a long-term view to what kind of behavior we want companies to have. And I think if those investors take up the challenge of trying to address nutrition issues and engage with companies to push them to take recommended global actions, then we may see some improvements.   Bio   Gary Sacks is an Associate Professor based at the Global Obesity Centre at Deakin University, Australia. Gary's research focuses on policies for improving population diets and preventing obesity. Gary has co-authored several international reports on food policy, including the Lancet Commission on Obesity and several reports for the World Health Organization on obesity prevention. Gary co-founded INFORMAS (International Network for Food and Obesity / non-communicable diseases Research, Monitoring and Action Support) – a global network for monitoring and benchmarking food environments. Gary leads the component of INFORMAS dedicated to monitoring the actions of food companies in relation to obesity prevention and population nutrition. Gary led the first-ever studies to benchmark progress on obesity prevention by Australian governments and food companies.  

This podcast focuses on why now is the right time to fix the US food system. I'm talking today with Marla Feldman, Senior Program Director at MAZON: A Jewish Response to Hunger, which is a national advocacy organization working to end hunger among people of all faiths and backgrounds, in both the United States and Israel. As our regular listeners will know from previous podcasts, for 36 years, MAZON has worked towards systemic change to address hunger and its root causes. This is done through a combination of initiatives, including programs with low-income populations or problems that have previously been overlooked or ignored, including food insecurity among currently serving military families, among veterans, single mothers, Native Americans, LGBTQ seniors, and the people of Puerto Rico and the territories. This is the fourth in our series of episodes in partnership with MAZON. And this time, we'll focus on the organization's work to increase access to nutritious foods in the charitable food network.   Interview Summary   So Marla, I know there's been a significant shift in thinking about nutrition in the context of food banks, and that this topic was addressed in an influential report that MAZON put out in 2018 titled, "A Tipping Point." Can you explain what things were like prior to that, and what prompted you to write the report?   "A Tipping Point" did have a significant impact on the field. Prior to the report, MAZON worked for years to improve nutritious food options offered in food banks. It was probably 2005 or 2006 when we began a conversation on the links between obesity, hunger, and health, when not many people in our field were discussing this yet. We then launched our first formal initiative around nutrition and healthy eating in 2007. So "A Tipping Point" was really the culmination of a decade of work for MAZON. After many years of working with food banks around the country, helping them to implement strategies that facilitate the acquisition and distribution of healthier foods, we wanted to collect data to take a closer look at how successfully this work was going, to improve the nutritious offerings through food banks and the charitable food system.    Prior to "A Tipping Point," there was momentum building in the field for sure, as food banks across the country began to prioritize the health and wellness of those they serve. And they were trying various strategies, including to increase the distribution of fresh produce and other nutritious offerings. But the kind of data gathered in our report did not exist, and has since been instrumental in helping to assist the field to gain even further momentum around nutrition and as a benchmark to gauge progress, especially when it comes to the less-helpful foods in food bank inventory.   So what were the main recommendations in that report and what have been the most significant developments in your mind since then?   Well, "A Tipping Point" was impactful for many reasons, and I'll talk about in a moment, the recommendations, but I'd say one of the biggest impacts it had was providing data that jolted the field and really served as a lever of change. The data we reported was and still is used to support and fund several important national projects, including Robert Wood Johnson Foundation's Healthy Eating Research, which since developed HER nutrition guidelines that Feeding America has adopted for food banks to use as a strategy for distributing more nutritious foods. But one of the most impactful findings that we reported, which has been and continues to be cited throughout the field, showed that 1/4 of the inventory distributed from food banks at that time was empty calories, or as some refer to as junk food, meaning that it was not nutritious food. These included sugar-sweetened beverages, candy, and sweet and savory snacks. And that data point was eye-opening for so many. And in contrast, about 1/3 of the food they were distributing was fresh produce. So the recommendations we provided, which included the development and implementation of formal nutrition policies, the development of national nutrition standards, and to update the metric system with one that measures the nutritional value of foods distributed, these recommendations helped many national organizations obtain funding so that food banks across the country who wanted to implement similar nutrition standards had the data, the support, and the strategies to do that.   Now, if I can just editorialize for a moment, this is a big deal because just Feeding America alone is an enormous organization that has purview over food banks all around the country. And if the nutrition standards can change in an organization that big, and others, then vast numbers of people who rely on food banks could be affected in a positive way through their nutrition. So congratulations to you and your colleagues for helping accomplish this, and others who've worked in the field as well. And I'd also like to bring attention to the Healthy Eating Research guidelines that you mentioned, which I think are outstanding, and really have been helpful. So let's change the topic a bit and discuss COVID-19. So during the pandemic, how has the increased demand on emergency food assistance services created even new challenges?   The need for emergency assistance services like food pantries skyrocketed in the pandemic. Nearly 80 million people faced food insecurity at the height of COVID-19. Many people facing hunger also struggle with diet-related health conditions like diabetes, heart disease, and obesity. So it became even more important that food pantries helped promote healthy eating and provided more nutritious foods. COVID-19 also exacerbated the racial disparities that already existed with food insecurity. Black and Hispanic families have always been disproportionately impacted by hunger. And COVID-19 had an out-sized impact on these same communities. One positive outcome has been that food pantries have expanded their community services and support. So they always offered certain services like SNAP enrollment, but the pandemic required them to expand these offerings and reevaluate how they'll serve the community moving forward, which has the potential to create a positive impact even after the pandemic ends. So the pandemic has also made clear, if not obvious, that charity alone cannot end hunger in this country, it was never designed to do so. That's why MAZON has doubled down on our advocacy to protect and boost programs like SNAP, which is designed to enable people to get the food they need with dignity. And we were very pleased and excited to see the recent USDA decision to update and increase SNAP benefits so families can reliably access an adequate healthy diet.   So lots of progress has been made, but I'm assuming there's still a lot that can be done. So why is it important to continue discussing this issue of healthy food options in the charitable food sector, and what do you think should be done?   Well, it's so important to talk about healthy food options in the charitable food sector, because until the safety net is strong enough, we are going to continue to need the charitable food system to bridge the gap where SNAP falls short. We also know that, unfortunately, some people face obstacles to accessing SNAP, and they still rely on food pantries and other direct service providers. And these obstacles range from policy barriers, to misinformation, to stigma and shame. So a stronger, more robust safety net has already proven to lift families out of poverty until they have more resources and no longer need to supplement their SNAP dollars with a food pantry visit. But right now, some families cannot get by on SNAP dollars alone, and as a result, those families cannot access enough nutritious food to adequately feed themselves and their families. There's more we can do as well. There are many stakeholders that play a key role in the charitable food system. And one of the most important are the large corporate and retail food donors. As our report revealed, food donations make up approximately 60% of the inventory at food banks. So the food donation stream has a very important role to play in making sure that the food in the charitable food system is more nutritious. "A Tipping Point" aimed to influence food donors and offer solutions, whether through education and engagement, policy, tax credits, or otherwise that would incentivize healthier food donations. So again, all stakeholders, including food donors and the corporate community, play a key role in the food provided at our food banks and food pantries, and all stakeholders can improve efforts to make the charitable food system healthier so that we're nourishing the people who need this vital support.   Bio   Marla Feldman is the Senior Program Director for MAZON: A Jewish Response to Hunger. Since joining the organization in 2002, Marla has led efforts to promote positive health outcomes and improve access to nutritious food for low-income communities. Marla has spearheaded national initiatives, including Healthy Options, Healthy Meals™, which encouraged food banks to prioritize nutrition and implement strategies to procure and distribute healthier food through the charitable food system. Most recently, Marla conducted a national food bank study and published the findings in the research report A Tipping Point: Leveraging Opportunities to Improve the Nutritional Quality of Food Bank Inventory. Prior to joining MAZON, Marla spent nearly a decade managing small business development programs with the African Development Foundation and the Peace Corps. She holds a Bachelor of Arts in Communications from the University of Maryland.  

Researchers and policy makers in agriculture, food security and nutrition share a common need for accurate and timely information on the what, when, where, and why people eat and what they eat, of course, this is particularly true in low and middle income countries where the data infrastructure is less well developed to put this challenge in perspective in 2015, the Global Panel on Agriculture and Food Systems for Nutrition reported that, and I quote "more than half of the countries in the world do not collect the statistics, which are needed to assess whether or not they are making progress toward their nutrition goals." So today we're talking with two researchers who are working to solve this very data challenge.   Our guests are food policy and applied nutrition researcher, Jennifer Coates, Associate Professor at the Tufts Friedman School of Nutrition, Science, and Policy and senior researcher Winnie Bell. Jennifer and Winnie are leading development of the International Dietary Data Expansion Project   Interview Summary   Jennifer, let's start with you. Your research focus at Tufts is on the development of methods for improving the design implementation and evaluation of international nutrition and food security programs. And I know in particular, in the context of development in humanitarian emergencies. Could you help our listeners understand the issue of this INDDEX Project that you're working on?   Jennifer - Just to give a little bit of history. The international community has probably over the past five or so years really begun to embrace the need to think about nutrition's role at the nexus of agriculture and the environment and health. So not just a standalone sector, but rather a culmination of whole bunch of different forces within the broader food system that in combination have this remarkable impact on people's food choices and ultimately their diets. So we also know that in turn, the food choices really drive health outcomes and in a very systemic fashion affect agriculture, the environment, food security, poverty, and so on. So the problem though, for those who are interested in the interplay of these forces in much of the world, is that we know shockingly little about what people eat and we're not able to easily distinguish the dietary patterns of adult men, for instance, from school age girls or from those living in one region of the country to another. And this information gap has really hindered policies in all of the different sectors that I mentioned and others, because policy makers are often driving blind without having more frequent and more granular dietary information. This data gap is particularly a challenge across low and middle income countries.   So let me follow up on this. It seems like this information is pretty darn important because it could drive nutrition guidelines for countries that could drive bio-fortification programs. They could certainly have an impact on agriculture policies.   Jennifer - There are a number of different reasons, in fact, for one thing, we're globally really lacking a kind of cohesive dietary data infrastructure, I will say, and this is made up of several different missing pieces of information. So we lack the kind of information that can help us actually carry out dietary surveys. So information on what are the most commonly consumed foods across many of the countries where people live and also what are the nutrient composition of that food in the US for instance, we have a very rich repository of data on the foods consumed by people all over this country, including many, many different kinds of processed foods. And we also have information on the nutrient content of those foods. And so it makes it very easy to take that information and go out and conduct a survey on what people are consuming, but we don't have that kind of information for most low and middle income countries. And another reason is that partly because we lack this dietary infrastructure, people have over time, come to view dietary data as being very challenging to collect and have shied away from it because of that. So now we're reaching a point, I would say, where we're seeing a groundswell of recognition for the need for dietary data and then that is driving a lot of efforts, not just our project, but other related projects that are really trying to begin to close this gap.   I appreciate that hopeful note. So Winnie, you're leading key aspects of the second phase of this project, which is the rollout of the INDDEX24 dietary assessment platform. Could you describe the platform in more detail and why you believe it is needed.   Winnie - The INDDEX project, the International Dietary Data Expansion Project has been around for about six years. We started in 2015 with funding from the Bill and Melinda Gates Foundation, and our main objective has been to increase the availability access and use of dietary data in low and middle income countries. The platform is designed to address some of these underlying challenges that Jenny just spoke about.   INDDEX was conceived to begin to address the lack of dietary infrastructure for collecting individual level quantitative dietary data. One part is the Global Food Matters Database where we house and fold all of the dietary reference data that are required for individual level food consumption surveys. So that includes food composition information, standard recipes, necessary conversion factors, and the probes that are used during the interview process. So that's the first kind of big component of the INDDEX24 platform.   The next piece is the INDDEX24 mobile app, which is actually what's used in the field to collect the dietary data during the survey, both of these pieces are connected through a survey management hub where the data can be monitored in real time during data collection, as well as used for easing the processing and analysis of the 24-hour recall data on the backend. So the 24-hour dietary recall method is commonly used to collect detailed quantitative information on what individuals consume. Individuals are asked to recall everything that they consumed in the past 24 hours followed by a more detailed information on each of the food items, getting into that type of food consumed and the brand, for example, the third step is to then collect the quantity of each food consumed and then finally reviewing that information with the respondent.   All this might sound a bit abstract, so I would encourage listeners to check out our website for a full visual and a demo of the different aspects of the platform and in terms of why it's needed. And this, as Jenny highlighted, we have this critical gap in information and this platform has been designed to increase a collection of 24 hour dietary recall data in low and middle-income countries.   This could be enormously powerful to have this tool available and it's really nice that you're doing it around the world with a special emphasis on countries where the data are most lacking. So Jennifer, let me go back to you in your opinion, how has the international nutrition and dietary assessment landscape changed over the, say the past decade and looking into your crystal ball, how do you think it will change?   Jennifer - I mentioned earlier, one of the reasons there has traditionally been so little dietary data available is that it was often written off as being too expensive, too time consuming and too difficult to collect. So traditional dietary assessment methods, such as those that rely on respondent recall can also produce inaccurate results, which people recognize and were discouraged by this narrative. This ridiculous challenge of dietary data assessment really became a mantra, it became almost paralyzing I'd say, one of the biggest changes that I've noticed over the past five to seven years is an acceleration on so many fronts. There's been an acceleration in terms of the demand for dietary data, absolutely. And then in response, but also out there leading, I'd say those involved in generating dietary data have developed a new can-do attitude, a real rolling up the sleeves and just getting it done.   Partly this has been catalyzed by very generous funding by the Bill and Melinda Gates Foundation, not just of our project, but of other similar projects with INDDEX24 we're trying to make dietary data, I guess, increasingly available. We're hoping that it will be collected more frequently and therefore be used by policy makers more often, but there are also other aspects of the dietary data value chain that other projects are addressing. For instance, the WHO/FAO GIFT Project has been working to make dietary data more readily accessible in a centralized repository and much more usable by policymakers, through simple visualizations that communicate very readily to those who aren't up to their eyeballs and dietary data, and might not know otherwise how to interpret it. So this kind of information has improved on the way that people both access and use dietary data.   And then looking forward, one of the things that we're seeing are a huge number of efforts going on to develop innovative technology. Much of it is still nascent, not quite ready for prime time, but to improve the possibility of capturing information on diets in real time, like while people are eating, researchers are using imaging approaches coupled with artificial intelligence in order to upend the traditional field of dietary assessment. So, no, we're not there yet, we've already made leaps and bounds on this front, over the last, over the past 10 years and I think that 10 years from now this whole challenge will look completely different, in fact, I think we will probably have done away with many of the things that we now find to be very difficult about dietary assessment.   What you just mentioned about technology being used to more accurately assess what people are consuming sound very promising. And I remember back when I was first paying attention to work in this area, and there were a lot of concerns about the accuracy of things. Researchers were reporting that people may not be able to accurately judge portion sizes. They may intentionally under or over report consuming such things. And there was talk in those early years about having other information available where you could correct for things to actually establish a more realistic number. So say people underestimate by an average of X %, then you could correct for that, are people doing that at all? Or will this technology help with that issue?   Jennifer - There's work going on for both of those fronts, so you're absolutely right, that those types of corrections are possible and are actually very useful. One of the things that is very challenging right now in our efforts in low and middle income countries is that we don't actually have enough information yet to really be able to establish appropriate correction factors. One of the reasons for that is that, for instance, in the US people most commonly under report, what they've consumed the previous day and that's partly because they forget, and it might also be because they think it might be more socially acceptable to under-report. But we really don't know all that much about how people from various cultures report their diets, when they're trying to recall, there is documented under-reporting.   There's also documented over-reporting and there's a lot of variability establishing the correction factor is a whole other level of work that would be very helpful and remains to be done. One of the benefits of the imaging technology is that you're not relying on people's memories. And in fact, the camera is present, even though that sounds a little creepy, big brother watching everything that you're eating, but the camera is present and often in an unobtrusive way, as people are eating their meals. And so of course you might be concerned about people modifying their behavior, if they're aware of a camera recording, what it is that they're eating, but at the same time, some of this research has suggested that having the camera be situated in a very, very small way on, the special glasses that people be asked to wear or as a button that they wear on their shirt, for instance, has really helped reduce some of that kind of potential bias too. So there's a lot of promise from the imaging and there are still challenges to be worked out for instance, how to take the images that the camera's capturing and in a very automated way, convert that into something that can be recognized as food, especially in complex dishes, like stew with lots of different kinds of ingredients. So that's kind of the excitement, but also the challenge of this new frontier.     That's really interesting. So let me close by asking you both this question moving forward, what do you see as the biggest challenges as well as the opportunities for increasing collection and use of dietary data in low and middle income countries? And Winnie let's begin with you.   Winnie - So, as we've both mentioned, the dietary data infrastructure has been historically one of the largest barriers to successful completion of dietary surveys in low middle-income countries. The INDDEX Project has been focused on trying to build up this research infrastructure over the last six years of our project. But the challenge remains is it an enormous undertaking that really will require political will from a variety of key players and champions from both governments as well as on the donor and investment side, as well as on the research end of things. We're absolutely moving in the right direction, but I think the challenge remains, how do we develop this robust and necessary dietary data infrastructure to ensure that we can collect more easily and use more frequently the dietary data from low middle-income countries.   We have successful examples of this being developed where political will has converged. So in the health sector, for example, we've seen huge movement over the last several decades to creating health systems in low middle-income countries. So we're hoping that the momentum continues to grow, to overcome this challenge in relation to nutrition. And as far as opportunities, I think there are several, but a very concrete one is on the technology side of things as Jenny mentioned with artificial intelligence and other efforts. And I think the other overall opportunity is general growing awareness of the importance of dietary data. Everybody is interested, everybody wants to see the results, and historically people are happy to have the data available, but few people have been willing to put in the effort to invest and collect those data.   Thank you, Winnie. So Jennifer, what are your thoughts on this issue?   Jennifer - I'd say that with dietary assessment in low and middle income countries, having historically been such a neglected area relative to say the many advances that we've seen in terms of information systems in the health sector, there has also been a lack of opportunity for very vibrant knowledge exchange. There are countries that have developed a lot of expertise and a lot of capacity in the area of dietary assessment and yet the kind of infrastructure that would enable country to country learning as well as training and mentoring between those who have already amassed a deal of experience in dietary data assessment, and those who are trying to improve their skills in this area has really been lacking. I'd say that the flip side opportunity to that challenge would be to scale up a global community of practice that can serve as a platform for exchange, for training, for learning and for maintaining this positive momentum that we've seen over the last five years. So we need to be thinking about the next generation and equipping them with the tools and the skills and the capacity to be able to carry this forward.   Bios:   Dr. Jennifer Coates is the Principal Investigator of the INDDEX Project and is an Associate Professor at the Friedman School of Nutrition Science and Policy and a Senior Researcher at the Tufts Feinstein International Center. Dr. Coates' research focuses on the development of methods and metrics for improving the design, implementation, and evaluation of international nutrition and food security programs in both development and humanitarian emergency contexts. In addition to her research and policy engagement, Dr. Coates teaches a range of graduate courses at the Friedman School.     Winnie Bell is a Senior Researcher with the INDDEX Project. Winnie was responsible for leading the INDDEX24 research activities in Viet Nam, including conducting the feasibility and validation studies. In addition, she is providing technical expertise and managing the development of the INDDEX Project's Data4Diets Platform. Prior to joining the INDDEX Project, Winnie had worked for over five years as food security analyst and researcher with the Food and Agriculture Organization, the Food Security Information Network (FAO/IFPRI/WFP), and Tufts University. Winnie is currently a PhD candidate at Tufts University, where she also earned an MS in Food Policy and Applied Nutrition and an MPH in Epidemiology and Biostatistics.       

The COVID-19 pandemic changed our lives and led to mandated business and school closures, families and communities all around the country experienced record levels of unemployment and record levels of food insecurity. This led to unprecedented policy innovation designed to increase access to nutritious food through the supplemental nutrition assistance program, known as SNAP. The program that was formerly known as Food Stamps. In today's podcast, we'll talk with the authors of a new report entitled, Supplemental Nutrition Assistance Program Waivers and Adaptations During the COVID-19 Pandemic, A Survey of State Agency Perspectives in 2020.   Interview Summary   Our guests today are two of the authors of the report, health policy expert, Alyssa Moran of the Johns Hopkins Bloomberg School of Public Health, and Matt Lyons, the Director of Policy and Research with the American Public Human Services Association.   So your report addressed how states responded to the increase in need for SNAP during the pandemic. Matt let's begin with you, can you tell us more about the report and why it was important to document the state experiences?   When the pandemic first hit last year, the sharpest spike and need for basic help was in SNAP. And this isn't a typical and economic downturn SNAP has always been one of the most effective tools to help meet people's basic needs and to stimulate local economies. This time around though, we had to weather an economic crisis that was layered on top of a public health crisis, and that dynamic raised all kinds of new questions about how state agencies were going to get help to millions of families in a world that literally shifted to virtual overnight. In those first weeks of the pandemic, we as the membership association supporting those state agencies, we were literally convening state agency leaders on Zoom calls daily just to figure out basic questions of how are you going to keep the lights on so that staff could keep processing applications when they're working from home? Or how are you going to navigate through federal requirements that frankly were developed at a time when SNAP was assumed to be a program people applied for in person? And as difficult as that was for our agencies to make sense of, we could only imagine how infinitely harder that was for all of the people that were trying to apply for help. So as federal policies and guidance started to catch up in the coming weeks and months, and states really settled in for the long-term COVID response, states had to plan for how they're going to adapt their services so that people could keep accessing the benefits through the duration of the pandemic. And as we worked through all of these monumental changes to how the program is being administered, it really just became self evident that it was crucial. We had to take the time to rigorously document this experience and just draw on all the insights and lessons learned so that we can improve access to SNAP in the long-term and strengthen its impact on peoples and communities based off of this experience.   Well, some of the problems, the challenges you mentioned make perfect sense now that you've brought them up, but they're not the kind of thing most people would think about, and you could imagine how hard it must've been to keep things going that even a modest level, much less been ramped up. So Alyssa, I'd like to hear your thoughts on this.   I'll preface this by saying that I'm a public health researcher. So I think about SNAP through that lens, and from a public health perspective, SNAP is a tremendously important program. It reaches about one in eight Americans and nearly half of those participants are kids. And it's a critical program for reducing poverty and improving food security, which are really important social determinants of health affecting everything from dental caries to diabetes, to depression. But the design and the delivery of SNAP also really better for health. For example, there are obvious ways that design choices in SNAP affect health equity, things like eligibility criteria, which prevent certain people from accessing the program or decisions about the benefit amount, which affects the types of foods that are available to participants. But there are also more subtle ways that program delivery can impact health, something as simple as how the state communicates with you about your benefits. So did they send you a text message right to your phone, or do you have to call a call center and wait on the line for two hours for information? Can you submit all of your application information online or do you have to come into the office for an in-person interview? So all of these requirements to enroll and stay enrolled in SNAP can affect health by limiting or expanding access to benefits and can also cause significant stress, increased anxiety and cause people to worry about whether they're even going to actually receive their benefits each month. And as Matt described, the pandemic acutely changed how states deliver SNAP and how participants interact with the program. And I was really interested in learning what we can take away from this experience to strengthen the public health impact of SNAP moving forward, not just by breaking down barriers to access, but also by improving the client experience through these structural changes.   It's nice to hear of the interest among public health researchers in helping improve the delivery of these programs, because as you said, they reach so many people. Matt, you mentioned that there were program changes that needed to be made in SNAP during the pandemic, how successful do you think these changes really were in helping states serve their clients?   Well, in those first few months of the pandemic, you had more than 6 million people newly enrolled in SNAP and participation has remained well above pre pandemic levels as a nation have continued to grapple with all of the disparities in the COVID response and recovery. So I think from this perspective alone, it's important to consider the SNAP pandemic response a success. Fundamentally more people needed help affording food during the pandemic and the program was responsive. We've all heard the stories of it taking weeks, if not months for unemployment insurance systems to respond to the spike in demand and to be able to issue new benefits. And that just wasn't the case for SNAP. State and local agencies really did step up to the table to meet the challenge, but I will say SNAP's ultimate success, it certainly didn't come without its fair share of bumps in the road. And I think that probably starts with the fact that SNAP rules, they're just not well suited to work in a virtual world. When you think of things like interview requirements and procedures for recertifying for benefits and even things like a signature requirement, they all lean heavily on in-person interaction. And that's particularly true for underserved communities that already face access barriers.   For our clients, if you mess up and following those rules, you're back to square one, you got to start all over in the application process and even beyond just the benefit itself, there's other components of SNAP that are there to help people receiving a help learn more about healthy food or engage in employment and training services. And those services are similarly modeled towards in-person activities. So to say that the program had to make changes would be an understatement, I really think everything had to change about SNAP. And I will say to their credit, the federal government approved a broad range of temporary flexibilities to mitigate a lot of these issues.   But really, the devil is in the detail of whether these flexibilities can be successfully implemented. Early in the pandemic in particular, states would often not get approval for waivers that were really critical to help families keep their benefits until days before or even after an action was due in a client's case. The reality is that states needed to know weeks in advance. They could be updating their eligibility systems and sending out notifications to people receiving SNAP of what was expected of them. And these issues unquestionably led to unnecessary confusion and problems in the pandemic response. I will say fortunately, the federal government did learn from a lot of its early mistakes, in late September Congress passed new legislation that allowed for a lot more flexibility in states being able to select waivers, they could deploy over a longer time horizon and customized to their specific needs and implementation approaches. And that approach, it worked a lot better for states to be able to proactively plan how they could use these waivers and transition over time to a new normal. In the months after that even both Congress and the administration made a number of additional changes to help states provide more equitable benefits access. So I would say even in just the short period of this pandemic response, we've already come a long ways.   Alyssa, I'd appreciate your reflections on this issue as well.   The pandemic really forced states to think differently about how they interact with and provide services to clients. Some of those changes were successful and others existing deficits in technology, staffing models or community partnerships that were really difficult or sometimes even impossible to adapt during the national crisis. So one example of a change that worked well was the expansion of telephonic case processing. So this allows caseworkers to support client applications over the phone instead of in-person or online. And federal policy really facilitated that by allowing clients to give verbal signatures over the phone instead of a written signature. Before the pandemic, states had some options to do this, but they were required to collect and store an audio recording of the signature and purchasing that technology to be able to do that was a major barrier. So only some states were doing it and it wasn't always fully available statewide. So this flexibility that allowed for verbal signatures was seen as a really successful low-cost option facilitating remote services.   Another change I'd consider successful was the expansion of the online purchasing pilot. So before the pandemic, only two states allowed SNAP participants to use their benefits for online groceries, and now almost all 50 states offer that service. And we know that there are still a number of barriers to access, so things like few participating retailers, high delivery and service fees, lack of delivery particularly in rural areas, but it does represent a big shift towards modernizing SNAP, which was long overdue. On the flip side states also experienced some challenges moving SNAP online, particularly in communicating these frequent program changes to clients, shifting supportive services like nutrition, education, and workforce training to a virtual setting and engaging people who might lack reliable access to internet or digital devices. Very few states were able to provide mobile friendly services to clients, most relied on mass communication through their websites or social media or call centers. And even though most states were able to transition their supportive services online, somewhat, they tended to have difficulty engaging clients in this new setting.   So you both painted a picture of things that may be helpful to know in the future if there's some crisis like the COVID-19 pandemic, but also there's a lot to be learned about the way SNAP might be changed going forward overall no matter what's happening in the background. So Matt, let me ask, what are you taking away from this experience about making SNAP stronger and more resilient?   Well, I think that's the million dollar question. So the first thing I think that sticks out to me, we really desperately need a playbook ready to go should we ever face a crisis like this again. The time it took to get legislative authority from Congress so we could get SNAP rules adjusted and then the process of developing and refining USDA Guidance has a real insignificant cost on the people in the communities that need help. Being able to come into a crisis where we've codified automatic triggers that are most essential for SNAP to be responsive during a time of crisis that would really ensure that state and local agencies can hit the ground running with a plan and knowledge of what flexibilities they can use and how to best deploy them. This is needed around a lot of different issues.   I'd say most glaringly, we need to be talking about SNAP benefit increases and looking at suspending work requirements during a crisis, but we also need to look at those administrative rules that make a really big impact on how people access and participate in services. So things like interview requirements, the way that people can recertify for benefits, the use of telephonic signatures, quality control procedures, and then things for particular populations that have specific needs, looking at student eligibility rules, purchasing of hot and prepared foods. These all come to mind to me as things that we really need to come prepared day one of whatever that next crisis is to be ready to respond, to be nimble and adaptive.   The second thing that sticks out to me is we have learned a tremendous amount about what works and what doesn't work in SNAP this past year, and we should use it to strengthen the program. Many states have found that the amount of meetings and paperwork that we're required to put people through, it really does little to preserve program integrity. What it does do is it places a lot of significant administrative burden on families. So less rigid interviews and change reporting requirements can help us cater the program to better support people that are participating. And I think federal pilots demonstrations that could test alternative strategy that could help states build the evidence for what best practices work and what contexts, that's really needed right now and the time is critical that we be thinking about that as we transition out of the pandemic.   Thanks, Matt. And Alyssa, what are your thoughts on this?   Testing ways to minimize participant burden is really critical. And what we've learned during the pandemic is that a big part of that is investing in technology to expand the ways that people can interact with SNAP. So one example that I think is helpful is thinking about what it's like to do your taxes now versus what that looked like even 10 years ago. So if you recall, you used to have to go to your accountant to file your paperwork in person, if they needed more information they had to call you, or you had to come back into the office. If you got a refund, you'd have to wait for weeks for your check to arrive in the mail. And now I can easily submit everything online. I can chat with an accountant on demand. There's a streamlined process to file state and federal taxes all at once. And I can easily track my refund on my phone and even have it delivered to my virtual wallet. So if we can use this best available technology to do our taxes, why can't we expect the same services for SNAP? And I think these kinds of changes that make it easier to get and keep benefits, not only have potential to break down barriers to participation and reduce participants stress and anxiety, but will also make SNAP much more adaptable and responsive in future crises.   We found that states were largely constrained by the technology they had available before the pandemic. Very few were able add or expand modes of interacting with clients while they were in crisis mode. And understanding best practices and providing these virtual services is key. So there's a real need for investment in technical assistance and research to help states better understand how clients interact with these remote services. What are some of their strengths and limitations and what are some of the access barriers for certain groups?   And then one last point I wanted to lift up is the importance of making SNAP more client centered. One thing I personally learned through this work is that state performance is evaluated using metrics like payment errors and application processing time, and this can come at the expense of customer and staff satisfaction. So in thinking about modernizing SNAP, it's really important to center the client voice and to really value the lived experiences of participants to improve customer service and to ensure that we're prioritizing equitable program access. Something that one state said that really resonated with me is we need to put the human back in human services.   So the report is co-branded and coauthored by Johns Hopkins and the American Public Human Services Association. So Alyssa, how did your two organizations come together to do this work and why do you think this relationship between the organizations is so important?   Alyssa - Working with APHSA on this was like a dream partnership. They have such deep working knowledge of SNAP policy which we try to understand as best we can as researchers, but can't possibly keep up with all of the intricacies of implementing these program changes on the ground. And the team at APHSA provided that policy context and made sure we were asking really relevant and meaningful questions. And they also offered a direct line to the people we really wanted to get our findings in front of. So often when you submit a policy research grant application, they ask about your plans to disseminate findings to key stakeholders. And depending on the research, it can be really challenging to figure out who to contact and how to communicate your message in a meaningful way. But for APHSA that's their bread and butter. So they already have these great relationships with Congressional and USDA staff, and they know exactly how to communicate the research in a way that will resonate with them. So that made getting the word out to policymakers really easy.   Matt - Recently, we had a chance to preview the final report with our state SNAP directors. And one of the comments that just really stuck out to me was hearing how this report is just a gift to have this kind of information readily available at your fingertips to be able to drive and inform future changes that are needed to make SNAP programs more equitable and resilient.   Bios:   Alyssa Moran has more than a decade of experience working with individuals, community organizations, and government agencies on food and nutrition programs and policies. Currently, she is an Assistant Professor of Health Policy at the Johns Hopkins Bloomberg School of Public Health, where she is Core Faculty within the Institute for Health and Social Policy and Impact Specialist in Obesity and the Food System. Her research, teaching, and practice focus on the role of food and social policies in improving diet quality, reducing food insecurity, and eliminating health inequalities. She is a registered dietitian, earned her MPH in public health nutrition from NYU in 2011, and earned her ScD in nutrition from the Harvard Chan School of Public Health in 2018.   Matt Lyons is the Director of Policy and Research with the American Public Human Services Association (APHSA). In his role, Matt is responsible for developing and executing strategies for policy advocacy and influence in areas impacting health and human services programs. Prior to joining APHSA, Matt served in a variety of roles in state and local government, including administering economic support programs for Maryland's human services agency, managing disaster recovery programs for the State of New Jersey in response to Superstorm Sandy, and coordinating the delivery of housing and healthy homes programs for the Baltimore City Department of Housing & Community Development. Matt also has worked for a non-profit research institute where he provided technical assistance, data analysis, and information system design and implementation for low-income energy efficiency and community services programs across the country. Matt has an undergraduate degree in Government and Politics and a Master of Public Policy from the University of Maryland.    

America's children and teenagers spend tremendous amount of time on the internet and never more than during the Coronavirus pandemic, with families at home so much, people ordered food, got news and engaged with family and friends online. Youngsters whose schools closed, relied on YouTube for educational videos, attended virtual classes on Zoom and to Google Classroom and flocked to TikTok, Snapchat and Instagram for entertainment and social interaction. This cost of digital immersion has a serious health downside however, because the nation's youth have been exposed to a steady flow of marketing for fast foods, soft drinks, and other unhealthy products. Today we'll be discussing a new report from the Center For Digital Democracy entitled, "Big Food, Big Tech, and the Global Childhood Obesity Pandemic."     Interview Summary   Our guests today are Jeff Chester, Executive Director of the Center for Digital Democracy and Senior Strategist Kathryn Montgomery, both are dogged and their work on this topic and in my mind are true pioneers.   So Jeff let's begin with you, before we dig into the nuts and bolts of the report could you explain to our listeners the role that data play in online food and beverage marketing? What kinds of data are the companies collecting and how?   Well today you no longer can separate marketing and advertising from data, data collection, data analytics, and data use, whether you're online doing any of the activities you just mentioned that kids were doing during the pandemic, where you go to the grocery store and use your loyalty card, go to the gas station, even pass a billboard, data about you is increasingly being collected, everything you do, everywhere you go, and not only you, what your family does and what your friends do and what your community does. All that is now collected and harvested. So personalized advertising can be delivered to you regardless of where you are and what you're doing. And food and beverage companies have been in the forefront taking advantage of all this data to push very unhealthy food marketing to children and teens.   So Jeff you painted this picture of a lot of data being collected of a lot of people and so I'm assuming this applies to children as well as teenagers when they're visiting the internet - that their data are being harvested and that gets used to market things specifically to them. So is that correct?   It works in a number of ways, even though there is a children's privacy law that supposedly limits the amount of data that can be collected on children under 13. In fact, companies collect huge amounts of data, they violate the law on children, and certainly teens are easily accessible by the data companies, but it's not just personal data, it's data about their families. So for example, the companies now know what mom and dad buy at the grocery store or the commercials even that the kids watch at home for example, when they're viewing streaming video or just regular television, so all that data is compiled. Let's talk about family data in addition to personal children's data, that's used to target advertising to them. What's important in the report is that today the food and beverage companies have become kind of Google's and Facebook's, the food and beverage companies are now leading data companies as well, which illustrates how much they value and understand the role that data plays in targeting audiences today, not just the United States, but throughout the world.   It's a very concerning picture, especially given that there is a law meant to protect this population that's being violated. So we'll come back a little bit later and talk about what might be done, but Kathy, how has the COVID-19 pandemic impacted the way children and teens are being exposed to this food and beverage advertised in the digital world?   First of all, we know that children are already online in huge numbers, and that they're living their lives in this digital environment, they're conducting their friendships, they're interacting with people all over the world, using their mobile phones constantly, they are already in this digital ecosystem, as the industry likes to call it, 24/7. With the pandemic that was intensified, these young people were in greater numbers for a multiplicity of purposes. So they were perfect targets. They were in the crosshairs of the food industry and the tech industry constantly. And particularly for black and brown kids, this raises a lot of serious issues. And we also see some important intersections between the COVID-19 pandemic and the obesity pandemic, which is really one reason why we wrote this report. We wanted to have people understand how these two global pandemics are connected and that many of the young people who have been most at risk for COVID-19 have been those who suffer from childhood obesity and the related illnesses to that condition like diabetes, etc. These young people suffered from COVID and were more inclined to be very sick and sometimes die from it in greater numbers than other young people. And then at the same time, we have this huge pandemic of obesity that unfortunately in the US has fallen off of the public radar. That's another reason why we wanted to raise this issue and let people know about it. But in terms of black and brown youth, they are really in the cross hairs of the food industry. They are more avid users of digital media, they're on the gaming platforms in greater numbers, they're fully immersed and they're trendsetters for other young people. And the food companies have enlisted some of the icons of pop culture from these communities to promote some of the unhealthiest food you can imagine from fast food to sugar sweetened beverages and to do it through games, mobile technologies, every possible digital venue.   Let's talk just a little bit more about that if you wouldn't mind Kathy. So one might think that on the internet kids are just gonna be seeing the ads that they would have seen if they were watching TV, it would be similar things, they'd be seeing the sugar beverage company advertising its products with some athlete or some music celebrity or something, but you're painting a picture that's a little more serious than that. There are clever things that are done, it comes in different forms on the internet that can be especially hard to note as advertising, tell us a little bit more about that.   Kathryn - For a lot of people who as you say might have an understanding of commercials on television which we all can see and we can all get outraged about, but it doesn't work that way on the internet. The brands are really woven intricately into the inner relationships that young people have with digital culture. In gaming for example, you see brands woven into the so-called game play. It's done in a way that is personalized to each game player. They can crop up in the middle of a particular part of the game, they can be offered as rewards or ways to enhance your character's ability to fight a battle for example, or in some cases like with one of the Wendy's campaigns, they've created entire games based on character, so that's one example. And the other thing is that there's a lot of influencer marketing in this environment where influencers on social media will promote our brand to all their followers. And it doesn't look like advertising. It looks like recommendations, and it may be even more subtle than that.   Jeff - And unlike the commercials that many of us have grown up with, digital advertising is different, first place it learns about you. It learns what you like, what you do, how you respond, and it's able to change increasingly in real time. So for example, an ad or marketing message that you might view on your mobile phone is going to look different. It's going to be enhanced, adapted in some way. When you see the same ad, when you're on a gaming platform or a streaming video platform, these ads are increasingly personalized. And the ability to constantly track you wherever you go and use that data to create very relevant, engaging real-time advertising, which of course has been tested, measuring whether or not it triggers your unconscious and emotional spheres is one of the reasons why this powerful medium needs to be regulated.   So Jeff, the issue of marketing targeted this specific groups came up earlier, does that happen in this context?   Digital advertising works on an individual basis, on a group basis, the ability to leverage all the data that's collected today, and the fact that we live our lives in the pandemic enhanced that, on these digital platforms, enables the advertisers and marketers to create vast numbers of targeting categories. And also to understand that even if you don't buy, let's say junk food product X, that because of the habits of others who may have the same interest as you, but who do buy a junk product X, you're a potential target. And then they can then focus on you, even if you've never shown any interest in this particular food product. So there's just a growing number of ways to leverage data, to push unhealthy products, to young people that we've ever witnessed.   So I'm imagining that both the sheer amount of such marketing is of great concern, but also the fact that it's so precisely targeted and data are being used so effectively in this context probably gives the company as much more punch for every dollar they spend or every minute they have of your attention. So this is especially concerning. So Kathryn, what can be done to limit children's exposure to this type of marketing in the online world. And does the report make any specific recommendations in this regard?   We made a number of recommendations and we were so disheartened when we started this research that so little had been done recently, this was an issue that was discussed much more publicly. And a lot of us were involved in these efforts, not that many years ago where the concern about childhood obesity was really on the public agenda and companies were under some pressure to report to the Federal Trade Commission, for example, on how they were spending money to advertise to young people, and that has not happened in recent years. Interestingly, a lot of that has happened overseas. So in the EU countries, in the EU, generally in the UK and Latin America, there are stronger rules. And this issue is very much on the agenda. These are also global companies. So one of the things we've done in this report is to inform people about what's going on globally and to see how we need to look at U.S. policy in the context of global trends and the rising concerns in other countries about this issue. We have a long list of things that we recommend to policymakers and to companies. We think that the tech companies, for example, have some responsibilities and they've not stepped up to the plate on these issues. They play a major role here in the way they set up systems to facilitate and enhance this kind of marketing in the same way they did with the election. And what we learned from controversies over the Cambridge Analytica scandal, for example, so companies can do things to restrict what marketers can do on their site. So for example, we're very concerned that we need to do more to protect adolescents. They're very vulnerable to this kind of marketing. They're very much influenced by their peers. They have other kinds of vulnerabilities that make them particularly susceptible to the techniques that are used by digital marketers. We also believe that we need to look very closely at setting some clear standardized guidelines for what unhealthy food and beverages are. And I'll tell you everything we found in our report was unhealthy, whether it's the soft drinks or the French fries or the candies or the energy drinks that are commonly promoted aggressively on gaming platforms for example, we need to have clear guidelines about what can and can't be promoted. And we also need to focus on brands because if you restrict a certain product, but you don't restrict the brand, research has shown this causes young people to increase their consumption of unhealthy food. We list a whole bunch of techniques that are unfair and manipulative that needs to be addressed, particularly targeting black and brown youth. There needs to be a really clear focus on ensuring that is stopped.   So I'd like to ask Jeff in just a moment about some more of the policy implications for this and what might be feasible and effective in the context of what government can do. But Kathy, let me ask you one additional question. I know the food industry has for a number of years said, government doesn't need to regulate us because we'll regulate ourselves and they set up the children's food and beverage advertising initiative, which was an industry sponsored organization that was supposed to protect children from the marketing of unhealthy food, what happened to that? And why isn't that enough?   Kathryn - First of all they made sure that they only set up self-regulatory guidelines that applied to children under 12, not even 12 and under. So they've done nothing about adolescents at all. And they've been adamant about not wanting to do anything in terms of protecting adolescents. Most of the provisions focus on television, a few deal with digital, but not in a really adequate way. And generally what we see is there's no enforcement, there's no oversight. So you look at the techniques, you'll see that really these marketers are getting away with murder.   Jeff - And that's why the public health community and people who are concerned about public health and especially obesity need to start focusing on the food and beverage companies, as well as the platforms like Google and Facebook and take that snapshot because they are responsible for unleashing all these techniques, which we catalog. And until the industry feels the pressure, hopefully from regulators, these self-regulatory regimes will not in fact respond. What we found is not a secret. This is all known. And yet the people who were supposed to protect our nation's youth from this unhealthy group marketing simply have their heads purposely stuck in the digital sand.   So Jeff, are you any more optimistic that the social media platforms will have more effective self-regulation than the food companies do?   We're moving to a period of regulation, I think that the days of self-regulation are over, we have an unprecedented opportunity with the Federal Trade Commission now. President Biden has appointed someone who might be the most progressive champion of consumers and children and public health that we've had in decades. Her name is Lina Khan from Columbia University. She just took over a few weeks ago and we're seeing really a major overhaul. Now the Federal Trade Commission, which has the power to examine the data practices and the marketing practices, especially when it comes to the children and young people. We have a real opportunity to have the FTC act In this regard, in Congress, there is bipartisan interest to strengthen the rules that protect both young people and teens from a number of these data collection practices, which would have a direct impact on the ability of the companies to advertise and market junk food to them. And we're very helpful, right now we're on a path to try to reign in the power of big food and big tech, but it's certainly going to be an uphill battle. Too few people understand that the battlefield to protect young people's health in terms of obesity is really online.   It's nice to hear your optimism, that the FTC is one possible avenue for change. Are there other policy routes that might be effective? For example, can the states do anything on this level?   You are absolutely correct Kelly that the state attorney generals are taking a leading position in trying to break up Facebook and Google and Amazon really can and should play a role. The state of Ohio attorney general, a Republican has proposed that Google in essence, be declared a public utility, which would allow all kinds of regulation in state to protect the consumers, to protect the public. So, yes, there's also opportunities at the state level and even perhaps at the municipal level, in terms of the regulation of broadband, for example, or wireless communications, question is, is there enough capacity and interest and frankly support within the public health advocacy and professional scholarly community to start doing some of these things, because there's really just only a tiny handful of organizations working on this. And it's still frankly, very under appreciated.   Bios: Jeff Chester is Executive Director of the Center for Digital Democracy (CDD), a Washington, DC non-profit organization. CDD is one of the leading U.S. NGOs advocating for citizens, consumers and other stakeholders on digital privacy and consumer protections online. Founded in 1991, CDD (then known as the Center for Media Education) led the campaign for the enactment of the Children's Online Privacy Protection Act (COPPA, 1998). During the 1990s it also played a prominent role in such issues as open access/network neutrality, diversity of media ownership, public interest policies for children and television, as well the development of the FCC's “E-Rate” funding to ensure that schools and libraries had the resources to offer Internet services. A former investigative reporter, filmmaker and Jungian-oriented psychotherapist, Jeff Chester received his M.S.W. in Community Mental Health from U.C. Berkeley.   Kathryn Montgomery is Professor Emerita in the School of Communication at American University, where she founded and directed the 3-year interdisciplinary PhD program in Communication.  She is also Senior Strategist for the Center for Digital Democracy (CDD). Montgomery's research, writing, and testimony have helped frame the national public policy debate on a range of critical media issues.  In the 90s, she spearheaded the campaign that led to passage of the U.S. Children's Online Privacy Protection Act (COPPA). She is author of two books: Target: Prime Time – Advocacy Groups and the Struggle over Entertainment Television (Oxford University Press, 1989); and Generation Digital: Politics, Commerce, and Childhood in the Age of the Internet (MIT Press, 2007). Montgomery's current research focuses on major technology, economic, and policy trends shaping the future of digital media in the Big Data era.  Her recent work includes numerous reports and articles on digital food marketing, children's privacy, health wearables, and political microtargeting. She earned a PhD in Film and Television Studies from the University of California, Los Angeles.

Evidence-based Policy relies on strong data and measurements. So if you want to improve a development target like nutrition, you need to be able to measure that. But with fisheries and aquaculture, we often don't have the metrics we need to make sound policy decisions. This podcast is a part of a series on fisheries and nutrition and a movement to bring fisheries into international food policy and programming.   Interview Summary   Welcome to the Leading Voices in Food podcast. I'm Sarah Zoubek, associate director of the World Food Policy Center at Duke University. My co-host today is World Food Policy Center alum and Michigan State University, fisheries social scientist Abigail Bennett.   We've got another full house of guests today with Harvard T.H. Chan School of Public Health's ecologist and epidemiologist, Chris Golden and fisheries planning analyst, Nicole Franz at the United Nations Food and Agriculture Organization, FAO.   So I'll just jump right in, garbage in and garbage out, is what I often hear researchers say when referring to making decisions based on bad data or essentially no data. In your view, what are some of the most important data and information gaps for fisheries and aquaculture, and then subsequently for developing policy that promotes their contributions to food and nutrition security.   Chris - One of the most interesting things is that as a society, we still don't know who is eating what and where. So we have all of this data on food production around the world. We have data on trade in many cases, but we don't really know who's eating things. What types of food they're eating, why they're eating it. And so all of these data are essential for us to understand food behaviors, nutritional status, and the emergence of sustainable food systems. Thinking about aquatic foods, we also have these same types of issues. Consumption data is really patchy. We also really don't understand how food is being distributed geographically within a nation by socioeconomic status, age group, or gender dynamics, we really struggle to understand how policies that increase aquatic food production or environmental changes that might shock aquatic food production, might have downstream effects on people's lives.   Nicole - Chris, you already pointed out really crucial gaps. So I would just like to compliment with two more. And the first relates to the nutritional value of diverse types of aquatic foods. Aquatic foods provide micronutrients and essential fatty acids, and obviously in a very different way between these different products. The nutritional value of a white fish filet is very different from the nutritional value of a portion of small dried fish that is consumed whole. And this small dried fish for example, is particularly important as part of the diet of large amounts of people, particularly in Africa, but also in Asia. So better understanding those nutritional values of the different aquatic food products can really make a major difference in ensuring that those who are most in need have access to highly nutritious and aquatic foods. For example, one way to use that knowledge and apply that information is through targeted school feeding programs.   A second data and information gap relates to the origin of aquatic food supplies. We often talk about catch about the production volume but there's less information currently available on the underlying production system. So who is catching that fish and what species is produced by what kind of production system. National catch statistics are usually not differentiating for example between large scale and small scale fisheries. But knowing these underlying production systems is really of crucial importance to inform food security and nutrition sensitive policies. Small-scale fisheries for example, they tend to fish a larger variety of species than industrial fisheries. And this variety then also tends to be consumed while what is coming from industrial fisheries, a good part of the catch is often not used for human consumption.   In 2012, the World Bank, FAO and WorldFish worked together on a study that was called Hidden Harvest: The Global Contribution of Capture Fisheries. And in that study, it emerged that half of the global catch in developing countries is in fact produced by small scale fisheries. Even more importantly, the study found that between 90 and 95% of the small scale fisheries landings are destined directly for human consumption. So this really provides a strong justification to understand what the underlying production system is, because it has policy implications.   Abigail - Nicole I'd like to ask you a little bit more about the Illuminating Hidden Harvest study that you mentioned and the kinds of data and metrics it uses to understand the contributions of small scale fisheries in particular to food and nutrition security.   Nicole - Thanks Abby. In fact, the Illuminating Hidden Harvest study was inspired by the 2012 Hidden Harvest study. It is expanding the scope to better capture the nutrition and food security aspects in relation to small scale fisheries. So we're partnering with WorldFish and with Duke University for the production of this Illuminating Hidden Harvest study. And this is an attempt to contribute to closing, or maybe at least narrowing some of the current data and information gaps by providing more evidence on how small scale fisheries in particular contributes to sustainable development. The methods we have developed consists in data that we collected from 58 countries and territories. We also have submitted a survey that was replied to by over 100 countries, and we're also drawing on existing global databases. So we're combining all of this information in order to better understand the contribution of small scale fisheries to sustainable development.   One of the things we're doing in the nutrition work is building on work that was conducted by Christina Hicks from Lancaster University to model the nutrient content from fish. This is also an attempt to model nutrient content more widely, and this should be helping to value catch in terms of nutrition rather than only in terms of economic value. The catches from small scale fisheries are really very valuable in terms of nutrient richness, especially in terms of calcium of iron and zinc. And these are three nutrients that are often lacking in the diets in particular in low and middle-income countries. So these findings are incredibly important from a policy standpoint because they're showing the need to secure small-scale fisheries production systems in the context of growing competition over access to water in coastal areas, but it really underlines the need to maintain those important food production systems that are servicing so much nutrients to in particular, the most vulnerable and marginalized parts of populations.   Within the Hidden Harvest study, we're also using an indicator of household proximity to fisheries to understand better how the consumption of fish supports the nutritional benefits of the consumers. And this has really helped to illuminate how important fisheries are for the diets, especially for some groups within the population, including children between six and 24 months, which is really critical window for nutrition. So having access to affordable nutritious aquatic food is fundamental and using this indicator of household proximity to fisheries, has really helped us to visualize how the benefits from small scale fisheries are distributed within a country.   Abigail - Thanks, Nicole, that's really exciting. How can listeners access the results when they're available or keep up with the study as it progresses?   Nicole - We have a website and we're also sending out newsletter and we're sharing how the study is progressing. And we are planning to release a study at the end of the year, and it will obviously be available online on the pages of the three three partner organizations, FAO, WorldFish and Duke University.   Sarah - Chris, you had mentioned various databases. Can you explain a little bit more how that's filling the data gaps for diet and nutrient considerations for fisheries and aquaculture? What are we measuring here?   Chris - There are so many different types of databases in different parts of the world being produced by different users and all of them are so important, particularly in the ways that they can be used together. I'm going to list the ones that I've used in my own work or am aware of. The Global Nutrient Database is jointly produced by FAO (the Food and Agriculture Organization) and IHME (the Institute for Health Metrics and Evaluation). And it produces an integrated nutrient supply estimate for all foods that are produced with the expectation that they are being consumed at the national level. And so you have consumption data that is then matched under nutrient composition tables to understand approximately the nutrient supply at the national level. If you do some modeling to estimate how those national supplies are being consumed at sub national level across age and sex groups, you can actually make estimates of nutrient deficiencies at the national level. This becomes really important in terms of targeting what types of food interventions or nutritional interventions need to be undertaken at national scales.   There's also something called the Global Dietary Database based at Tufts University that has aggregated most of the world's 24 hour recall data considered to be the gold standard for dietary assessment and has aggregated all data that was conducted in nationally representative ways, I think it's for more than 80 countries, to understand how food items are consumed, how they're distributed sub nationally. And so the information within that, that allows us to have an idea of how the Global Nutrient Database might be disaggregated at sub-national scales.   There's also a database called GENuS, Global Expanded Nutrient Supply Database. This is a unique database in that it is completely open access, it can be found online in the Harvard Dataverse and it also produces nutrient supply estimates that uses the FAOs food balance sheet data, and then assigns nutrient composition data to the food balance sheet data and corrects for ways in which production might actually be translated into consumption.   The last thing that I'll mention is that we have recently developed something called the Aquatic Food Composition Database. We noticed how important the diversity of production systems of species, of the parts of fish that people were consuming and how little we knew about the nutrient value of those different parts of fish. And we went through a systematic scoping review of all of the data that was available in the peer reviewed literature. We went through all of the national food composition tables, and we wove that together into one integrated database and we called it the Aquatic Food Composition Database. And this has more than 3000 different aquatic food species, inclusive of both plant and animal source foods, an entire suite of different nutrients. From iron, zinc, individual fatty acids, protein, vitamin A, vitamin B12, etc. And then also classifies data based on whether it was wild, farmed, what geographical region it was produced in, and the part of the fish that is being tested. So whether it's the filet, the liver, a whole fish, whether it's dried or fresh. So any processing that is involved before the nutrient analysis was done. I think with all of these different methods, all of these different databases, putting together all of these data and disparate parts, and these unconnected databases will be incredibly important to understanding how we can create more efficient, more sustainable and more nutritious food systems.   Abigail - Chris and Nicole, you both laid an amazing amount of work out on the table. And it's really exciting because it does seem like the field is inching closer to being able to connect some of those dots and do some triangulation on some areas where there's some uncertainty and data gaps. And so yeah, I do want to circle back around to this initial question that we posed, which is so what is the significance of this work collectively for policymaking? What does this data enable us to measure about fisheries and agriculture and what are some of the implications for making better policy?   Chris - I think one of the things to look at is the way that the aquaculture industry is really revolutionizing feed. We know that aquatic foods on average are so much more sustainable and have a much lighter environmental footprint than a vast array of different forms of animal source foods. So when we put it in that context, to think about the way in which feed products that go into agriculture, which is the dominant form of environmental impact for most of them and the way that they're being completely transformed by these interesting tech companies, to look at ways that we can use plant feeds with adopted or generated nutrient profiles that really improve the ultimate end product of nutrition. I think that that is something to definitely keep a lookout for, that will have incredible policy impact in terms of developing sustainable food systems.   And so one of the things that my team has been looking at is the degree to which fisheries management and specifically marine protected areas, could actually serve as a nutritional intervention. Conservation as a process could actually be not only a biodiversity and an environmental intervention, but also a public health intervention. And so the idea that a marine protected area could rehabilitate a fishery, provide spillover and increasing access to seafood to adjacent communities, is something that I think is so exciting to really reframe that mentally. And then to see if we can actually quantify the benefits of conservation to human health.   Abigail - And Chris does that serve as even an additional justification for fisheries conservation? Is it useful in that sense as well to kind of reframe these things like that?   Chris - I think so, absolutely. I think the degree to which we can think of all of these different sectors as serving multiple different purposes of the resource. And so to think of fisheries exclusively in an economic sense, really undermines so much of its true value and might lead to mismanagement from a fisheries management standpoint.   Abigail – Nicole, I want to turn it over to you and ask the same question. What types of policies do you think might emerge from a lot of the work in filling data and information gaps?   Nicole - I fully agree with what Chris just mentioned, and I think hopefully one of the major results of better data and information is that there's more integrated analysis across different policy domains, such as fisheries and nutrition. It would really allow for more coherence also across new policies. For example, these broader livelihood dimensions that are coming from the fisheries are really emerging and are valued. So by having this data, the fishery sector will really gain more recognition because currently we see often that it's overlooked, it's not taken into account even in food security and nutrition strategies in many countries. So by having more evidence about these values and these multiple functions of aquatic food within societies, this really should help better policy making and help to optimize the outcomes of these different policies that are playing together in a more coherent way.   There are a number of new global policy processes and policy instruments developing, taking aquatic foods more into consideration. One example are the Voluntary Guidelines for Food Systems and Nutrition. These Voluntary Guidelines were endorsed earlier this year and they specifically include aquatic foods. And we also see now in the preparations for the UN Food Systems Summit, that aquatic foods is entering more and more the preparatory process of this UN Food Systems Summit. They often call it blue foods instead of aquatic foods. But we see now that the attention is growing and that the number of informal dialogues and the number of events are organized around that theme because there is this recognition, that aquatic food is really part of the system and it generates all of these health benefits, which ultimately play out positively for society.   Sarah – And now one final question. What are you most excited about that's on the horizon for aquatic, or as Nicole said, blue foods?   Nicole - I'm excited about this increasing recognition of aquatic foods, beyond the fisheries policy domain. And one example, there's the UN, they just released for the first time a discussion paper specifically on the role of aquatic foods in sustainable healthy diets. I think that that is really quite important. This paper sets out a number of recommendations on how aquatic foods are part of the solution to really building resilient food systems and sustainable, healthy diets. There's one recommendation that specifically calls to democratize knowledge, data, and technologies, and to co-create meaningful knowledge and usable innovations. And that recognition of the role of data and information in this report, I think is quite powerful. And I hope that it will really kick off more work and more attention, and also the possibility to bring together all of the existing knowledge. Chris mentioned before, there are so many databases already out there, there's so much information, but this might be an opportunity to really connect all of these better and build analysis around it, that then can really be the evidence base for policy making in the future.   Chris - I completely agree with Nicole, this increasing recognition of fish and aquatic food products, it is incredibly important to elevate this recognition of how undervalued aquatic foods have been in the global food system. And one of the things I'm most excited about is not only raising the profile of that, but also integrating it and linking it directly into the terrestrial food system. We can't any longer deal with these two things as separate entities. There are enormous feedbacks in terms of the forage fish that are then used as fertilizer or feeds in terrestrial food systems, and the ways in which terrestrial food production, then leaches into affecting our rivers and lakes and coastal water systems. We can't think of these things as detached. We have to think of them as one integrative and holistic food system. Sarah - I wanted to mention, Chris, the paper that you noted is called Recognize Fish as Food in Policy Discourse and Development Funding.

Episode 150- Doc Coyle from Bad Wolves! This band has had  four number one rock songs on the charts, including their smash hit “Zombie” which is a cover of the Cranberries song.  Before he joined Bad Wolves he was in a band called God Foribd for 17 years, and he's also filled in for Lamb Of God, written blogs for VH-1 and Metal Sucks, and hosts his own podcast, the Ex-Man with Doc Coyle. We went down some rabbit holes together and we talk conspiracy theories, UFOS, politics, the media and all that stuff. And of course we talk music and Doc opens up a little about what happened with the change at signer for Bad Wolves. Overall, one of the most enjoyable episodes of the show for me. Hope you agree!0:00:00 - Intro0:02:10 - Doc's Secret to Not Aging0:03:14 - Fun, Responsibility & Focus 0:07:40 - Conspiracy Theories, UFOs & Aliens 0:16:00 - Government Agencies & Society Evolving 0:20:50 - Media, Fear & Skewed Information 0:24:45 - Doc's Early Musical Influences 0:28:24 - Slash - Favorite Guitar Player0:31:07 - "God Forbid" Band0:33:37 - Big Bands & Success 0:40:40 - Moving to L.A. & Promoting Yourself  0:42:40 - Ozzfest & Money on Record Contract0:44:50 - Playing with Other Bands & Writing for VH-10:48:50 - Touring with Meta Cohen 0:50:55 - Bad Wolves Cover of  "Zombie" & Cranberries Singer0:55:42 - Casey Jones of Phoenix & Special Guest Singers 0:57:30 - Tommy Vext Leaves Bad Wolves 1:03:20 - Social Media & Negative Comments 1:11:32 - Politics, Divineness, & Information Warfare1:19:10 - Monsters in the Shadows & Woke To Your Thing 1:21:05 - The South, Big Cities, & Politics 1:29:05 - New Singer for Bad Wolves & New Album 1:34:20 - Whitfield Crane of Ugly Kid Joe 1:36:30 - Water Charity & Interview Summary 1:39:10 - Wrap UpBad Wolves website:https://badwolvesnation.comWater Charity website:https://www.charitywater.orgWrite Me a Review on Apple Podcasts:(Scroll down to the bottom)https://podcasts.apple.com/us/podcast/chuck-shute-podcast/id1469337994Chuck Shute Podcast website:http://chuckshute.comSupport the show (https://venmo.com/Chuck-Shute)

Can software help urban planners tackle food access in big cities? The UrbanFootprint organization says yes. Fast Company named it one of the most innovative social good companies in 2021. Our guest today is the company's co-founder and CEO, Joe DiStefano. He's going to explain how city data and geospatial information can inform critical planning decisions about where to invest and to deploy resources to achieve urban food system resilience and to better support communities.   Interview Summary   So, let's set the stage for our listeners. What is your view of the urban food insecurity problem?   Well, today, according to our data, about 19 and a half million, nearly 20 million households, are food insecure today, and that means they don't have the financial resources to confidently put food on the table throughout a week or throughout a month. That is a growth of nearly 50% since March 2020, when the pandemic began. So, we had places that were already significantly food insecure, or households that were experiencing a lot of stress when it comes to food security before the pandemic, but this has been a pretty substantial uptick. In some of the hardest-hit states we're looking at one in five households that are food insecure. I think even more troubling than that is that more than 12 million of these households report what we know of as food insufficiency, and this means not having enough food to eat at some point in the last week. So, some of these places, Mississippi, Louisiana, Texas, New Mexico, Oklahoma, those round out the top five right now according to our data. This is where 20% of households, and in some cases greater, are food insecure. What this striking number suggests is that existing relief programs and the existing kind of complex supply chain on the food insecurity side of things are not quite meeting the needs of some of the most vulnerable Americans.   You know, there's been a lot of attention to food insecurity during COVID, and I sure hope that when COVID is in the rear view mirror, whenever that comes, that people don't forget that it was a very significant problem to begin with. But boy, you make a good point about how it's been even worse during the pandemic. So, how does the data and a geospatial software program help with this problem? Can you describe the platform that you're building and tie that to the challenges that city planners and communities face?   Just as a really brief piece of background, so I spent about 20 years effectively playing SimCity for real; that was my job. Those of you who know that game, we did that for real, right? So, we were out there building data-oriented models of cities, and then experimenting with the impact of changes, so if you put housing here, or a transportation system here, what are the energy impacts, the water impacts, the health impacts. So, come COVID, we really oriented that data facility and that platform in the direction of some of these really challenging resource distribution issues, and this is not something I actually knew a lot about a year and a half ago.   We started doing work in Louisiana right about beginning of the COVID crisis with some folks that we had worked with in the post-Katrina, Rita recovery days in 2005, '06, '07, and one of the first things that we learned is that this COVID crisis is a very complex economic crisis. It was very unevenly distributed across communities, so in many cases poor Americans, non-white Americans were really adversely hit by economic impacts in particular. As those economic impacts started to unfurl on the landscape, we saw some very significant increases in need for things like food, very significant increases in eviction risk, very serious challenges around being able to get to test sites and medical facilities as transit systems that serve the most transit-dependent Americans turned off overnight, or dramatically reduced service. So, when we sat down with officials at federal, state agencies and relief providers in Louisiana, one of the first things we learned is that there was very substantial concern as to how to get basic needs like food to this increasing number of Americans that were needing it. So, we put our data systems to work to begin to understand that, so data that we have traditionally taken for granted as relatively static, like those transit system schedules, for example, those were now changing by the day.    So, we needed to begin to adjust information about transit systems in order to understand how people can reach healthy food. Unemployment, which used to change by 0.1 or 0.2 every six months, was now changing at double digits every week. So, we needed to start bringing in more dynamic feats around unemployment. And then, very importantly, because the COVID crisis was being experienced so unevenly at a fairly detailed level, like one neighborhood versus another neighborhood was experiencing COVID and the economic impacts of COVID very differently, we put a lot of our work that we had traditionally put into developing urban planning and detailed data down to the block level, for example, to work in order to understand how unemployment was ebbing and flowing across the landscape as well. What that ultimately led to was the ability to estimate the need for things like food relief at a much more granular level than has ever been available before.   So, we built these food security insight datasets, if you will, that now can map at the block and neighborhood level the level of food insecurity, the level of food insufficiency, and now, even more importantly, the gap between food distribution and participation in federal SNAP distribution programs, for example, and need. So, what we ended up doing was taking the same tech facility and prowess that massive companies like Amazon deploy in order to get you a toaster or an Xbox eight hours after you order it, somehow this thing arrives at your door. Why is it that that same kind of technology and that same kind of intellectual prowess can't be deployed to get relief to the most vulnerable Americans?   So, I can't tell you how impressed I am by the sophistication of this data and how detailed it can be going block by block, neighborhood by neighborhood. When you started looking at the data that you acquired this way, were there things that surprised you?   Some of the things that were most surprising or most telling, really, was again, at the granular level, the distribution of this crisis really is quite uneven. So, you look within a single city like New Orleans, or Baton Rouge, or any city in America, really, you're actually going to see very substantial differences even within a mile or two in the level of economic stress that's been experienced that was there before, in many cases, but then has really been heightened or been experienced in the COVID crisis.   So, places that have high concentrations of the sectors that have been experiencing such high unemployment are pockets of really, really deep pain and high levels of food insecurity, high levels of eviction risk. These are places that are dramatically less resilient than perhaps a neighborhood four or five blocks away from it. These are places that are least likely to be able to withstand the substantial shocks that have been coming their way, in some cases for decades that have really been sort of heightened and accelerated. So, health shocks like COVID, economic shocks like unemployment.   There are large subsections of cities, large communities that have been living at the edge for a while that the COVID crisis really sort of pushed over that edge, and so now the really substantial challenge is to ensure that relief in the form of food relief and food benefits, but also eviction relief, access to opportunity and jobs that can actually lift people above that edge.   Relief needs to be targeted into these locations, and it has traditionally been very difficult to reach these communities and to target relief to these specific places. You can't just drop relief at the county level; you actually have to really target it, and that's why we've built these datasets and that's why we've taken the detail that, say, an urban planner, or a developer, or an e-commerce company uses to understand the landscape and now begin to apply this to larger resource distribution problems like food, eviction, and other categories.   Let's get even a little more concrete. So, if you were a mayor, you were a city planner, you were a city manager, how would you take this information and do things differently than what's being done now?   Where we're seeing the most value for this data right now is actually at the front line relief providers, and then at the state agencies, and ultimately, hopefully, the federal agencies that are responsible for the distribution of these very substantial benefit programs. So, you think of the SNAP program, which is the federal food relief program, or rental assistance programs that are now coming down and being accelerated by the federal government. This kind of data can specifically do a couple different things. It can help to understand at a very detailed level and a very up-to-date level the scale of this problem. How big is this problem? How is it changing on a weekly basis or a bi-weekly basis? Is our program actually addressing the need? Do we actually see reductions in the need, or improvements in the outcome? Are people less food insecure than they were before?   Traditionally, we were using datasets that get updated every 18 months in order to estimate today's situation. It is not enough to actually understand whether a program is working. So, the first thing is just the scale, but really, the most important piece is that distribution of the problem. So, if you're going to reach the most vulnerable people, you have to understand where they are, and unfortunately, most of these programs are application-based programs. People literally have to fill out an application in order to get relief. If you want to apply for SNAP benefits or WIP benefits, these large federal and food insecurity programs that are then administered by the states, you have to fill out an application. Well, unfortunately, those that are most vulnerable, riding that edge, are not generally filling out those applications. In many cases they don't know about these programs. In other cases it's just really complex. The SNAP application is many, many, many, many pages long. It requires all kinds of information, and it's difficult to do it, so what ends up happening is that states and community-based organizations that contract with states are out there helping to enlist more people in these programs to get them aid. But you need data. You need to understand where these people are, and you need to be able to very specifically map the gap between application flow, in this case, and need.   So, what we're doing is we're mapping not just food insecurity, but we're now working with the first aid agencies. We don't bring in any personal, identifiable information. We bring in where the applications are coming from, and we map that against the need, and now we can clearly articulate where the gaps are. What that means is that community-based organizations and state actors and staff people can be going out and specifically targeting with marketing activities and other activities the locations of vulnerable households.   The real goal is to get more people enlisted in these programs. There is substantial resource out there. The federal government today, through the American Rescue Plan, the American Family Plan, it is dramatically increasing the pool of resources, but that does not mean that those resources are going to get to the right people. I very strongly believe that this is this once in many generation opportunity to use the same kind of data and facility, like I said before, that Amazon uses to get you a toaster, to get these people the resources they need in a very targeted way.   Boy, there's so many implications of this work, and I'm really happy that you could provide some concrete examples right there. So, could this technology be used to do modeling and to predict which neighborhoods might become in special need of services and things? Could you predict changes and factors that are going to lead to more food insecurity or eviction rates, or things like that in a neighborhood?   Yeah, absolutely, and actually, I would say that's much more consistent with the kind of work that urban planners and others do generally, and the kinds of things I've done for the past couple decades. And so if you look at a community, there are factors. For example, access to healthy food, which is a geospatial question. How many people are within a five or 10-minute walk of a grocery store, for example? We can map that, we can articulate that, we can index that across an environment. What are the particular sociodemographic characteristics of this place? What are the other urban characteristics of this place in terms of accessibility to facilities, transit access, access to opportunity?   If you put those things together you can really map... Think about a resilience index, if you will. One of the things that we've been working on is building out a community resilience index for every block in America. What that allows us to do is understand this relative resilience of every place across a city, across a region, across a state, across the country. Those things are really very strong indicators. Places that score low on this resilience scale are places that are more likely to currently have and to have more food insecurity, more likely to have eviction risk, more likely to experience some form of harm in a climate event.   So, for example, we do a lot of work with the energy utilities. This is all kind of in the same basic wheelhouse in order to help them understand where failure to the power grid is more likely to induce harm in a community, places where folks have higher levels of underlying health conditions, very low access to automobiles so those people can't get out of a situation if there's a heat wave, or if there's a fire, for example. These are places where grid failure will have an outside impact. Those are the less resilient places in American, and what I love to see now is at the federal level, at least on paper, we're seeing a very substantial reported investment in the resilience of these places. That is going to tackle the underlying causes of food insecurity, eviction risk, climate risk, which is really unevenly distributed. Certain communities are far more likely to experience adverse impacts of climate than others, and unfortunately, it's mostly the traditionally more disadvantaged communities in America, and so we really have a lot of work to do to rise the resilience of those places in order to address these multitude of issues.     So, one final question. Do you get a sense of how people in the communities feel about this sort of technology, and are there privacy concerns? Are there just things that one might not think about if you're just looking at the overall picture and not going into the communities?   There are certainly privacy concerns with all of this. I think people are rightfully skeptical when any technologist comes in and says, "Hey, technology's going to solve this problem." I absolutely do not believe technology is going to solve this problem on its own. This is a place where technology can absolutely help daylight and target a response, but it's not going to solve all the underlying problems. So, I think it's very important. I'm not saying that we've got some panacea here; not at all. Food insecurity alone has got a very complex supply chain. But what I can say is that we can be deploying some very substantial technology and AI and ML to serve this problem.   On the privacy side of things, yeah, I mean, people are specifically applying, providing personal information on the applications, for example. We go to pains to make sure that our systems never see that information, and that's very important from the perspective of trust, and also to abide by very specific regulations around privacy and security, in particular in states like California that have rightfully so aggressive rules around that. So, our systems never see the name, the address, or anything like that, nor do the systems need to see that. So, we're making sure that that is safe and secure and that we can do this in a way that protects the integrity of data and privacy, and respects those that ultimately are receiving relief.   Bio: Joe DiStefano is CEO and co-founder of UrbanFootprint, a software company that serves the world's first Urban Intelligence Platform to public and private-sector organizations taking on the urban, climate, and social equity challenges of the 21st century. UrbanFootprint's data and web-based geospatial software unifies previously siloed climate, environmental, urban, and socio-economic data and helps governments, utilities, financial institutions, and urban and transportation planners to answer fundamental resource questions—where to invest, where to deploy resources, and where to optimize for risk, return, resilience, and community. Before starting UrbanFootprint, Joe spent more than 20 years as a leading practitioner in the urban planning and disaster response field, working with governments and enterprises across the globe in designing cities and new technologies to tackle critical challenges in climate, land use, mobility, hazard risk, and social equity.

People who fight against anorexia and binge eating also struggle with secrecy, isolation and shame. Eating disorders such as these are incredibly powerful and relentless forces in the lives of an estimated 70 million people both male and female, by the way, according to the National Eating Disorders Association. For almost 30 years, author and storyteller Susan Burton of the hugely popular public radio program "This American Life" hid her obsession with food and the secret life of compulsive eating and starving that dominated her adolescence. She recently published a memoir entitled "Empty" as a way to confront her disordered eating and claim the recovery that comes from telling her story. Interview Summary   So having worked in this area for a long time, I can't help but admire your courage and the vulnerability in writing such an intimate book about the struggle of your eating disorders.   I wrote it because I really found that I could write no other book. I started out trying to write a cultural history of the teenage girl, a book that would have intertwined that history with the story of my own adolescence but almost from the moment I sat down to write the first draft, this other story about the eating disorder that started in adolescence came out and was insistent. And I really resisted it for a long time. I was scared to write it but in the end, it was the thing that had the most urgency. It was so clear to me it was the story I needed to tell.   I know hearing the story will do a lot of informing to people about eating disorders and of the ravages that it can have on people. And then also give comfort to people who might feel comfortable coming out and telling their story, given that you have. So let's start at the beginning. How did your struggle with eating issues begin and what did it look like throughout your life?   Among the first stories that my mother tells about me are stories of my infancy, when I was a child who didn't like to eat. So it was always something that was in kind of the background, that Susan has the strange relationship with food. I was an unusually picky kid at the birthday party. I didn't want pizza. I wanted milk instead of Coke. But the way I felt about these preferences and food fears was I think sort of more important than the fears themselves. I had a lot of shame and unease with the fact that I ate in a way that was different from the rest of my friends.   So fast forward to maybe age nine which is when I went on my first diet. I wanted to look like another little girl at my swimming pool. This little girl, her legs were so thin that the legs of her swimsuit kind of gaped around them and that was what I wanted. I can't say exactly why I wanted that but I went on a diet for a week and my mother noticed immediately. She said, "You don't look like yourself. You're too thin." And that was sort of the last time for some years that I intentionally tried to lose weight. But then midway through my adolescence, my parents had divorced. I was sort of struggling to define who I was as many of us are in adolescence and also dealing with kind of the fallout of the divorce and that trauma. I unintentionally lost a couple of pounds in a stomach bug. And I found I had a feeling of lightness that I loved and I sought more of that feeling that I craved. And within a few months, I was anorexic and within a few months after that, I'd started binge eating which is a really typical trajectory: the binging following restriction, though I didn't know that at the time. But that sort of sent me into decades of using eating or not eating to manage uncomfortable feeling.   Wow, that's very powerful. So I think the friends and families of people struggling with eating disorders would benefit from hearing you explain something. Why is it so difficult to talk about this kind of a personal struggle and why is telling the story so important to recovery and survival?   It's such a good question. There's so much shame associated with eating disorders. And I think because a lot of us who have them blame ourselves. Eating disorders are illnesses. They're illnesses that can be treated. I was having a conversation with a fellow eating disordered woman the other day and she was saying, "You know, if you were depressed nobody would tell you, 'get over the depression yourself, treat the depression yourself, it's your fault.'" Actually, there probably are people who've had that message and probably times in our history when we have treated depression that way. But the point is that a lot of us blame ourselves for eating disorders and with, I think, especially binging, bulimia, any of the disorders that involve eating large quantities of food, there's a huge amount of shame, culturally, involved with the feeling of too much, of greed, of overeating. I think there's more shame associated with those than there is with anorexia, which is not to say that there's not also shame in anorexia but I do think that excess carries a particular kind of shame.   I agree with you that public education can be so important in this context because you're absolutely right. For somebody who struggles with eating less than ordinary, people say, well, how hard can it be just eat a little bit more? And then of course, people with binge eating issues, people say, "Well, why can't you just eat what everybody else eats?" And they don't realize how powerful and driven the impulses are that kind of drive this in the first place. And I think some more public education like what your book will do can be really helpful.   I think that that was among my motivations for writing it. I was so desperate for people to understand what this felt like. That it was a compulsion. That it's not easy to wrest yourself from.   So what did it take to motivate you to begin writing this memoir?   I think part of it was the feeling that this was the most important story I could tell but what I didn't realize until I was through writing it was that the most important thing that writing the book would do would get me to start talking about it. Because even though I told my story on the pages of this manuscript, I still wasn't really talking about it with the people closest to me in my life, with the people kind of at the next outer circle of my life. I wasn't even in therapy until I had a finished draft of the manuscript. So the book is the telling of the story and it's my own attempt to understand what happened. But talking and talking about it with others is I think the next step in my recovery and that's where I am now, talking about my story with others and trying to understand it that way.   We'll come back to the issue in just a moment of recovery and whether it's ever complete. But let me ask another question first. So some people think about eating disorders in the context of addiction and believe that curing the disease might look the way that alcoholics might tackle their addiction, let's say. So you've made that point that this analogy misses an important way of looking at things and that the process of recovery is never done. How can you explain please?   For a long time, I was always drawn to stories of addiction because I experienced my binging as an addiction and I thought that that sort of explained the illness. But my solution then, as a young woman in my twenties, was to essentially quit food. Was to become anorexic, which is not a solution. Which is perilous. Which is delusional. Which I was lucky to emerge from into the healthy woman that I did. So you can't quit food. Food is everywhere. We need food for nourishment. We want food for pleasure. Food is something that we can experience with others.   And so we have to find a way to live with this substance and maybe even learn to take pleasure with this thing that we feared might destroy us. But I will say and maybe this is leading to where you're going, for a long time, I was really invested in this idea that my binging had been an addiction and I wanted to sort of tease it out and figure out was the addiction to the substance? Was the addiction to the behavior? And those questions are still of great interest to me. But I think where I am in my process now is I'm extremely interested in, okay, well, what does recovery look like and what does that mean in terms of an eating disorder? What do the academic journals say it means and what do people who've been there say it means? That's the question that's really present for me right now.   So do you believe that recovery can ever be complete?   I mean, it depends on how we define complete. When I say it's a question I'm actively puzzling through, I really am. I think at the beginning of my work in therapy, I would have said I just want to think about food like a normal person. You know? I don't want to be so preoccupied by it. But you know, then as I got a little further into the process I realized, well, recovery is not just about changing my relationship to food, it's about looking at all the reasons that I use food in the first place and developing all of these other ways of coping that I've neglected, so that's part of my recovery too. Will I ever wake up in the morning and eat in sort of an intuitive way? I don't know. Like I said, one of the first questions you asked me was about trajectory with eating stuff and from a young age, I was always weird about food. So if we think of the etymology of the word recovery, it means sort of a return, or going back. And I think I'm trying to make something new. I feel like it's probably not an answer to your question. I mean, I'm actually curious about what you think the answer is. Is a complete recovery ever possible?   It differs from person to person and some people may feel it's behind them and all as well and then behave as such and everything is okay. And other people, it's a constant struggle and they have to really remain on top of things. So it probably varies a lot from person to person but it's interesting that you brought that up because I do believe it's a fascinating issue. Something else you mentioned a moment ago I find fascinating as well, back to the addiction topics. You said you weren't certain if you felt addicted to the food or the behavior. There's some interesting nuance there. Could you explain that?   This is something where I am coming at this very much as a lay person reading stuff in Google scholar. So take it as you will. But as I understand it, there's somewhat of a debate in the field whether the addiction is to the foods themselves, to say sugar, to highly processed foods, or is it a behavioral addiction more in the mode of gambling or shopping? So there's a neurological response of a dopamine hit but is that coming from the repetition of the behavior, or is it something that's coming from the food itself? I'll say for my part, when I was in the throes of binging, I felt something physiological. Like I felt like I needed sugar, I needed it to lift me up. I needed it to move and in that sense, it felt like my body was craving something. But at the same time, I also recognize that the way that a binge often followed a disappointment or just a feeling of unease, that's maybe more of a behavioral compulsion or pattern.   Of course, there could be a combination of the two. Biological things get turned into behaviors that then become compulsive and driven themselves. So, you know, there's work on food and addiction now that I know you're aware of and that combined with your personal experience really paints a fascinating picture. And boy, is there indeed for more people to be looking into this. Let's change tracks here just a moment. So you're a parent now of two sons. Congratulations.   Thank you.   How did becoming a parent add a new dimension to your struggles with food?   I was very aware that I didn't want to repeat some of the things that I'd grown up with. So for instance, I have a very vivid memory of back to school shopping with my grandmother when it was August before I was going to enter fifth grade and my sister and I were in the little dressing room and I was trying out a plaid kilt. And I remember my grandmother clapped her hands together and she said, "I'm so glad I have thin grandchildren." And that was kind of the family we grew up in. And there was a lot of emphasis on body size and on being thin. So I knew that I didn't want to send them messages like that. But what I didn't realize was that I was really still locked inside anorexia in a way that I was kind of blind to for much of their childhoods and I was also anxious and fearful about food in a way that I'm sure that I transmitted to them without being totally aware of it. So now my focus is on being able to talk about these things openly because secrecy was so harmful to me in terms of my eating disorder but also in my family of origin, there was a lot of secrecy that I think perpetuated my own secrecy. So being able to talk about these things together has been a really wonderful and healthy outcome of telling my story.     Bio   Susan Burton is an editor at This American Life. Her writing has appeared in The New York Times Magazine, Slate, The New Yorker, and others, and she is a former editor of Harper's. The film Unaccompanied Minors is based on one of her personal essays. She lives in Brooklyn with her husband and their two sons. Her memoir book Empty was published by Random House.  

Food insecurity strikes all corners of American life including the lives of military families. For the currently serving military families there is a barrier that makes it more difficult for them to qualify for needed assistance from the SNAP program. A person who knows a great deal about this is Josh Protas, Vice President of Public Policy at MAZON, A Jewish Response to Hunger, which is a national advocacy organization working to end hunger among people of all faiths and backgrounds in the United States and in Israel. This is the third in our series of episodes on food insecurity, done in partnership with MAZON.   Interview Summary     So, let's dive in and begin by talking about hunger and food insecurity in military families. So, when did you first learn about the phenomenon in this population?   So, let's just start by recognizing how shocking it is to talk about military families and food insecurity in the same sentence. It's remarkable that we even have to have this conversation. MAZON learned about these issues about a decade ago. We started to hear from a number of our partner agencies, food banks and food pantries around the country about an uptick in the number of military families that they were seeing coming, really out of desperation, for emergency assistance. Around that time also, there was a session at the National Anti-Hunger Policy Conference on military and veteran food insecurity and MAZON'S President and CEO, Abby Leibman and Mia Hubbard, our Vice President of Programs, were at that session and heard about some of the issues that came up. And then people left the session and that was it. Food pantries and food banks were doing important work, serving military families with emergency assistance, but there were some policy issues that were being ignored. And MAZON started looking into these issues to understand what was going on and recognized that there are some separate, and somewhat related issues, for currently serving military families and then the veteran population as well. For the currently serving military families there is actually a barrier that still exists, that makes it more difficult for them to qualify for needed assistance from the SNAP program.   You know, you're right. It's discouraging and depressing that this problem exists, but of course it exists in such a widespread manner, that it's all over. So, what are the challenges and the circumstances that military families face, that can lead to food insecurity in the first place? I mean, I assume not having enough money is the biggest problem, but what else?   So, not having enough money is part of the picture. I think some historical perspective is important here because the composition of our armed forces has changed. Historically it was single individuals who enlisted in the military, and single men really, And the housing for those single men was primarily on-base housing. The composition of our military has changed over time and also the way that we house our troops has changed. So, we have many more military families that serve. It's not just the individual, but it's a spouse and children that serve with them in a way. And at the same time that that's been happening, the majority of our military housing has moved to either off-base, or privatized housing. The reason that this is an issue is because those who live off-base, or in privatized housing receive a basic allowance for housing benefit from the military. The issue around food insecurity is that that BAH, the Basic Allowance for Housing, which is not treated as income for federal income tax purposes and for determining the eligibility for most federal assistance programs, the BAH is treated as income for the Supplemental Nutrition Assistance Program. And as a result, when you take the base pay, which is often low for a junior enlisted service member and you add on top of that their BAH, it makes them ineligible to qualify for SNAP. And the added complications for military families are exceptionally high rates of spousal unemployment. Before the pandemic, the rates were hovering around 22 to 24% and that didn't even take into account underemployment, or employment that was below professional training. Since the pandemic, those rates have been spiking. Close to a third of military spouses that want to work are unemployed. And so, when you just have a single source of income, that low rate of base pay for junior enlisted personnel, it can be really tough to make ends meet.   Well, what a remarkable set of challenges those families face and you can see why food insecurity would be such a big problem. So, can you tell us how MAZON is addressing this issue?   MAZON has really focused on the policy challenges and policy solutions that can make a difference around military food insecurity. Trying to remove that barrier to federal program has been the core of that work. We've approached it on a number of different fronts, both in the Obama administration and in the Trump administration and now in the Biden administration. We've been pushing for administrative changes to get the U.S. Department of Agriculture to exclude the BAH as counted income, so to remove that barrier to access SNAP for military families that really need that help. We've run into a number of obstacles through that administrative course of action, so we've also been addressing this legislatively and have pushed for proposals in the farm bill process. And most recently, the farm bill that was signed into law in 2018, unfortunately did not include a fix for this. As a result, we've gone through the National Defense Authorization Act, which is must-pass annual legislation. MAZON was instrumental in crafting a proposal that would be a bit of a workaround. It wouldn't address SNAP specifically, but the Military Family Basic Needs Allowance, which we helped to write as a provision, is part of the NDAA process that would give some added cash assistance to junior enlisted personnel whose households are at, or below 130% of the federal poverty level. We've had bipartisan support for this provision. It was included in the House version of the NDAA bills the past two years. Unfortunately, there's been some Pentagon opposition to this and the Senate did not include the provision in their version of the bill and it has not been signed into law yet. So, we're continuing to push for that in the current NDAA process and also working on engaging the administration. We've met with the First Lady's senior staff and staff from the Domestic Policy Council and National Security Council. The First Lady has re-instituted the Joining Forces initiative to focus on military families and their unique needs and challenges. So, we're hopeful that there's a growing awareness about this issue and a growing commitment to take some common sense targeted actions to really help those who are serving our country, to make sure that they never have to struggle to put food on the table.   I'm impressed with how sophisticated and persistent your policy efforts have been in both on the administrative and legislative fronts. Are you optimistic that things will eventually change?   I've been working on this issue personally for the past eight years. I've put a lot of time and energy into it. It's been a major area of work for MAZON, so, I'll feel comfortable and comforted when we get it done. I don't want to get too optimistic. This issue is common sense, as it is to address it has been so stubborn, finally get resolved. So, I don't want to be complacent at all. There are some reasons to be more optimistic that we'll be able to push this further. Certainly the change in the Senate, the new administration, signal some better opportunities, so I'm hopeful on that front.   Now, have been some recent stories about food pantries and other charitable organizations providing emergency relief to military families. And this is something you alluded to earlier. How adequately, do you think, they're addressing the issue?   So, the food pantries and food banks that are addressing this issue are really doing that at a surface level and they're doing very important work to respond to emergency needs. But for military hunger and for hunger in this country, in general, the charitable sector does not have the capacity nor was it set up to have the capacity, to fully address food insecurity issues in this country. Only the federal government has that capacity, has the resources, has the breadth and leadership to really address hunger. And we need policy solutions to deal with this. There are food pantries operating on, or near, almost every single military base in this country and there's no reason that should happen. Those who are serving our country bravely should never have to worry about meeting their basic needs. They should be paid adequately and they should be able to access resources in federal programs that are available, to provide some extra assistance if they need it. So, turning to a food pantry out of desperation shouldn't be a routine case. The pantries that are operating near these bases are serving the same families month in, month out, hundreds, sometimes thousands of families, at different installations. And that shouldn't happen. We should be able to make sure that those households, either get additional pay to make sure that they can meet their basic needs, or able to get benefits like SNAP, so that they don't have to turn to the charitable sector. And food pantries are already spread thin. They can't pick up any more slack. Certainly the needs have been spiking because of COVID-19 and the economic downturn. Our federal government needs to step up. The ARP that recently was signed into law is a huge step forward with the, SNAP benefits, but that's time limited and eventually that will expire, so more robust support for our federal safety net programs is critical. And certainly for military families, we need to remove those barriers and fill that gap.   You've been speaking, in a very detailed way, about food insecurity in military families. What is the scope of the problem among America's veterans?   Great question. And the issue for veterans is different than for currently serving families, but related. So, MAZON has been working on this issue, veteran food insecurity, for a number of years as well. We held the first ever Congressional Briefing on veteran food insecurity back in 2015 and invited leadership from the United States Department of Agriculture and the Department of Veterans Affairs to join us. And we learned, at that time, that the VA system was not doing food insecurity screenings as a standard practice. And if you're not asking the question and you're not screening to see who might be struggling, then you can't address the problem. So at that time, MAZON pushed really hard to get the VA system to start asking the questions, to start doing the food insecurity screenings that were so critical to identify those who are at risk in order to be able to connect them with available help. Really pleased to say that couple of years ago now, VA system has started doing these food insecurity screenings which has been an enormous step forward. The screenings that they were doing were just a single question, which probably were insufficient for fully capturing the scope of the problem and identifying all who might be at risk. It looks like the VA system is moving towards a question panel as part of its Clinical Reminder system, the hunger vital signs, which is a validated instrument that includes two questions to really identify who may be at risk of food insecurity and the severity of that food insecurity. Where there's a need now is connecting those veterans who are at risk of food insecurity with programs like SNAP and that's not happening as a routine practice through the VA system. And there's also a need to connect veterans who do not receive care and services through the VA system with resources like SNAP.   MAZON has been working with the VA. We assigned a memorandum of agreement with the VA system this past year and we've also worked with veterans service organizational partners to create resources and trainings. We created an online training course with the PsychArmor Institute, aimed at service providers who work with veterans to make them better aware of food insecurity among the veteran population. Some of the unique challenges, including shame and stigma that might make veterans reluctant to seek help and to direct them towards their state's SNAP agency, so that those who might be struggling in resources that they're eligible for and entitled to. A recent study about veterans who are food insecure, found that of those who are eligible for SNAP, only about one in three actually participate in the program. So, that means that two thirds of veterans who are dealing with food insecurity, are eligible for SNAP, are leaving those benefits on the table and are struggling needlessly. So, there's a real need to help close that SNAP gap for veterans. It's the right thing to do. It will help support better health. It'll realize long-term healthcare savings and it'll help those veterans who are trying to support their families, better able to take care of them.   Bio:   Josh Protas is the Vice President of Public Policy and heads the Washington, D.C. office for MAZON: A Jewish Response to Hunger. In this role, which he assumed in 2012, Josh coordinates and implements MAZON's advocacy agenda, including efforts to protect and strengthen the federal nutrition safety net, with particular emphasis on the food security needs for seniors, veterans, and military families. Josh has extensive experience working at Jewish communal agencies at both the local and national level including as Director of the Jewish Community Relations Council at the Jewish Federation of Southern Arizona and as Vice President and Washington Director for the Jewish Council for Public Affairs. He previously served as a member of the board of directors for the Coalition on Human Needs and currently participates as part of the Vote Advisory Council for Food Policy Action. Josh earned his M.A. in Western American History and Public History from Arizona State University and his B.A. in American Studies and French Literature from Wesleyan University.  

Today's guest, Dr. Robert Paarlberg, is the author of a provocative new book entitled: Resetting the Table: Straight Talk About the Food We Grow and Eat. The book is presented as a clear-eye, science-based corrective, to misinformation about our food: how it's produced, food companies, nutrition labeling, ethical treatment of animals, the environmental impact of agriculture, and even more.   Interview Summary   So Robert, The New York Times praised your book for - and I quote here - "Throwing cold water on progressive and conservative views alike." What an accomplishment that is, and with an intro like that I can't wait to talk to you today, so thanks so much for joining us. So let's begin here, your new book highlights a number of dietary health shortcomings in America but you say these do not come from our farms or from farm subsidies. Can you explain, where do they come from?   Clearly we have a dietary health crisis. Only 1 in 10 Americans is getting the fruits and vegetables recommended and meanwhile we're eating far too many ultra-processed foods with added sugar, salt, and fat, which is why 42% of adults are now clinically obese. I mean, that's three times the level of the 1960's and one result is approximately 300,000 deaths a year linked to diabetes, cardiovascular disease, and cancers. Now, some food system critics have tried to trace these problems back to the foods grown on our farms. That is, not enough fruits and vegetables and too much corn and soybeans and farmers in America do produce a lot of corn and soybeans but stop and think, nearly 60% of the soybeans are exported. So they never enter our food supply and more than a third of the corn is used to produce auto fuel. So, that's out of our food supply as well. And we've used imports to make an abundance of fruit and vegetables, available in the marketplace. Half of our fruit is imported, one third of our vegetables are imported, often, off season when it's too cold to grow these things in North America. Thanks to these imports, the per capita availability of fruit in the market today is 40% above the 1970 level and the per capita availability of vegetables is 20% above 1970. Actually, per capita, availability of broccoli today, is 13 fold what it was in 1970. So, what our farmers grow, is not the same thing as what consumers eat and very quickly, as for farm subsidies, they're often criticized for making unhealthy foods, artificially cheap but they actually do just the opposite. We have to remember the purpose of farm subsidies is to increase the income of farmers and that is best done, it's usually done, by making farm commodities artificially expensive, not artificially cheap. Farm programs make sugar, artificially expensive by keeping foreign sugar out of our domestic market, raising the domestic price by about 64%. We make wheat and wheat flour and bread artificially expensive, through a conservation reserve program that pays wheat farmers to keep their land in western Kansas idle for 10 years. And we make corn artificially expensive. It's said, that we're living with a plague of cheap corn, but it's just not true. We have a renewable fuel standard, that takes a third of total corn production out of the food market, for uses, auto fuel, and that drives up the price of soybeans as well because soybeans and corn are grown on the same land.   So back to the question then, if the dietary problems don't come from the things that you just mentioned and you make an interesting case there, where do they come from?   I put a lot of blame on food manufacturing companies, on retailers and on restaurant chains. These are the companies that take, mostly healthful commodities, grown on America's farms and ultra process them, add sugar, add salt, add fat, turn them into, virtually addictive, craveable products and then they surround us with them, all day long and they advertise them heavily, including to children. I believe we are drowning in a swamp of unhealthy foods, produced not on our farms, but downstream from farms by these food companies. Now the food companies say, "Oh, well, unhealthy eating, we're not responsible. It's an individual eater's responsibility, to decide what he or she puts in his mouth." But I don't buy that. I mentioned that obesity rates in the United States today, are three times the level of the 1960s. It simply isn't true, it can't be true, that American eaters are three times as irresponsible, as they were in the 1960's.   Companies can't be blamed, I don't suppose, for trying to maximize sales of their products and trying to maximize their desirability. How does it become a problem with the food industry though?   If a shoe company sells us too many shoes that we don't need or a toy company sells us toys we don't need or an auto company sells us a fancy auto with features we don't really need, that doesn't become a public health crisis, but when food companies make products that are almost impossible for most consumers to resist, if they consume them then, in excess and it does become a public health crisis, that's a different sort of problem. In a way, I don't blame the companies because as you noted, they compete fiercely with each other and if anyone were to try to go first to offer product lines, that weren't latent with excess sugar, salt, and fat they would lose market share. These companies actually need the government to step in and provide a common discipline on all of them. Either, in the form of excise taxes on sugar-sweetened beverages or regulations for, at a glance, nutrition guidance labeling on the front of the package or perhaps, restrictions on advertising food to children. If you look at the countries in Europe, 18 European countries have at least one of these policies in place. The continent of Europe has obesity prevalence, only half as high as that of the United States. So here, I think if we can learn something from Europe and use government policy to protect the companies from the kind of damaging competition that they've fallen into.   Given what you said about rates of obesity, it's important for people in many countries of the world to just, eat less food and of course, eating less food creates problems for the industry. So, it seems like, on one hand, the government to say, "Well, listen, why don't you require us all to gradually reduce the sugar in our products or the salt or the fat or whatever, so that we're all on the same playing field." People get calibrated to a lower level of these things and everything will be fine, but everything won't be fine because if those foods become less palatable, people will eat less and the companies will suffer from that. So, my guess is that that's why there's no appetite, if you pardon the pun, from the companies to do this kind of thing and why there's gonna have to be government regulation that overrides the company's political interest or even litigation to help drive this, what do you think?   I'd like to see strong public policies. Whether you call it helping the companies to, avoid their worst instincts and protecting them from damaging competition or imposing on them, a public health obligation to market fewer addictive and unhealthy products. I think, there's a great deal of room for public policy here and no matter what you call it, the companies by themselves, have created a problem that, it's unlikely they will solve, by themselves. In my book, I look at a food service chain, Applebee's, they realized, that their comfort food was not setting a proper health standard for their clientele and they tried to, change their menu, to take the, all you can eat riblets, off the menu and they lost customers. And so they got a new CEO and they went back to the old menu and their profits soared again. Companies sometimes try, they sometimes want to do a better job but in a unrestricted, competitive marketplace it can be suicidal. So, I think we should, in their own interest, as well as in the public health interest, put some restrictions on the marketplace or at least some guidelines   So let's move on to a little bit different topic. So your book questions some popular narratives, including suggestions that there should be more local food to scale up the consumption of organic food or say, to build supermarkets and food deserts.   Well, if you look at them one at a time, you'll see that they probably wouldn't improve our dietary health. If we relocalized, our food system, we would have to replace all those imported fruits and vegetables I mentioned, also seafood. If we tried to, replace those, with locally or at least nationally grown products, it would be possible to do, with enough greenhouses, but it would be very difficult and very expensive for food consumers in Chicago or New York or Boston, in the Northern latitudes, where many food consumers live. So, the price of healthy food would go up in the marketplace and we don't consume very much local food today. Actually, if you look at all of the direct sales from farmer's markets and CSA's and pick your own and roadside stands and farm to table and farm to school, it's only 2% of farm sales. It turns out that, we're not scaling up local. Consumers want more variety, they want more convenience. They want those things year round. I mean, we're actually going in a globalized direction. In 1990, we imported only 10% of the food we consume. Now we're importing 19%. Organic, it's a little bit similar. Currently only 2% of farm sales in America are certified organic products. The number's low because organic rules prevent farmers from using any synthetic nitrogen fertilizers and they're the most important source of productivity in conventional farming. Trying to scale up organic would make healthy food again, more expensive. Organic produce costs, on average, 54% more than conventional produce. If consumers had to pay 54% more for fruits and vegetables, they would buy less and eat less. Now, there are food deserts, where there is a relative shortage of supermarkets but there isn't any good evidence that building a supermarket in a food desert will improve dietary quality. In part, this is because supermarkets sell so many unhealthy foods. The Robert Wood Johnson calculates that only 30% of the packaged products in supermarkets, can be considered healthy. About 90% of the packaged products in supermarkets, are ultra-processed. So, a supermarket is really, a food swamp, surrounded by, a perimeter with some healthy food products and adding those kinds of markets to a poor neighborhood does very little to change a dietary behavior. And it's food swamps that are the problem. And it isn't just corner bodegas and convenience stores that are part of the food swamp. Even pharmacies now, are part of the food swamp. When I go to my CVS to fill a prescription, I have to walk through aisle after aisle of candy, soda, snack foods, junk foods to get to the pharmacy counter. So, I can try to protect my health and spoil my health in a single visit.   Interesting way to look at it. Let's end with this question. So in your book, you have favorable things to say about plant-based imitation meats and you chide the food movement activists for rejecting these new products because they're processed, why do you defend them?   Well I don't defend them on the strictest nutrition ground. An impossible burger or beyond burger isn't much better for you than real beef patty, particularly if you have it with a soft drink and fries, but I defend these products as substitutes for real beef because for environmental reasons, they have a carbon footprint that's 90% smaller than a real hamburger and they use 87% less water, 96% less land and also, risks to human medicine, that come from our current use of antibiotics in livestock production. The problem of antibiotic resistance is a serious threat to human medicine. That problem disappears when the livestock aren't there and also, animal welfare abuse disappears. Now I know food movement activists don't like plant-based meats because they're ultra-processed or because they're patented or corporate or not traditional or artisanal, but these critics have to come up with a better way to reduce our over consumption of animal products, before I'm willing to join them in criticizing plant-based substitutes. I mean, the fashion industry has switched to imitation fur and the shoe industry has switched to imitation leather. So, why shouldn't we allow our food industries to shift to imitation meat?   Bio: ROBERT PAARLBERG is adjunct professor of public policy at the Harvard Kennedy School and an associate at Harvard's Weatherhead Center. He has been a member of the Board of Agriculture and Natural Resources at the National Research Council, a member of the Board of Directors at Winrock International, and a consultant to the International Food Policy Research Institute, the U.S. Agency for International Development, and the Bill and Melinda Gates Foundation. He is the author of Starved for Science, Food Politics, and The United States of Excess. He lives in Massachusetts.

Hunger affects all communities, but you may not know that 40% of single mothers struggle with food security. Women dominate our central workforce, yet they face persistent structural barriers to food security and economic stability. COVID-19 has only exacerbated these challenges. Today, Abby J. Leibman, President and CEO of MAZON: A Jewish Response to Hunger, discusses the urgent and unique needs single mothers face, and the work she's leading to advance the anti-hunger movement.   Interview Summary   So MAZON has recently started developing this area of work related to food insecurity amongst single mothers. Can you tell us more about it?   Yes, and I think one of the things that has always distinguished MAZON has been our ability to look around at the world of the American population struggling with food insecurity, and identify places where there are populations or communities or issues that have gone under-addressed by other large national anti-hunger advocacy organizations. And the number of people who struggle with poverty in America is, of course, in the millions. A significant portion of those are women who are struggling to take care of themselves and their children. Those single mothers constitute one of the most significant, yet under-addressed, communities in our country when it comes to all kinds of social services or social justice efforts. We felt that it was a moment in time when we could lift this up and we should lift it up. Contributing to that, of course, is that during the pandemic. We know that there are a lot of communities that have been more affected than others, and single mothers are among those. In large part because many of them are essential workers. So they're being pushed in a lot of different directions with little relief that is specifically designed to meet their unique needs.   That statistic that I mentioned in my introduction that 40% of single mothers suffer from food insecurity, boy, what a toll that must take.   Yes.   Can you explain that picture a little more?   I think that in large part, it really takes two incomes to adequately support a household. There's very few of us who can say that a single parent or a single salary in a two-parent household is adequate. And when you begin to look at what the lives of women are like when they are single parents, you can see why there are these pressures that fall on them in a way that's different. We know that in this country, if you are taking care of children, you cannot actually leave them alone when you go out into the paid workforce. So this notion of the relationship between work and care-taking is something that I think a lot of economic structures in this country pay lip service to and do very little to relieve. For better or for worse, the vast majority of those that are the primary caretakers of children are women. So even in a two-parent household, you can see that women are shouldering a lot of the responsibility around that care-taking, but they also have the flexibility and the freedom to be able to work either part-time or afford to have paid childcare for those children. When you're a single parent, you're it. You are the person who has got to provide both, that economic security and the parenting responsibilities. And then we look and we say where women are actually ghettoized in a lot of low-paying jobs, that now, we call essential. But I would say up until the pandemic, we dismissed those jobs as being something that were unskilled or unappreciated. We've suddenly awakened to the fact that these are very vital roles in our economy and in the way we live our lives in America.   So how do programs like SNAP help single mothers, and also, maybe more important, how do they fall short, particularly in the wake of COVID?   SNAP is an amazing program because it is flexible enough to meet the needs as they grow. This is what an entitlement program is, and it's one that has worked beautifully. Now it's underfunded because what we're talking about is not a lot of money. Even with the new increase that we've seen in the American Recovery Act, that number is actually another $28 per person a month, which is not that much money. But when you are trying to feed your family, it's really vital resources. But SNAP itself is not meant to be the full amount of money that anyone could live on. It's the Supplemental Nutrition Assistance Program meaning that the program itself is supplemental. You should have some other kind of financial resources here. So it's already designed to be a program that is not going to be fully funded to create that kind of full budget for your family. Women have these particular challenges about work and feeding families. And the way that the SNAP program has evolved over time is despite being an entitlement, Congress has layered into this requirements that people work outside the home as they struggle to get their footing. So there's something of an unfortunate irony here. I mean, SNAP was not designed to be a work program, but it's functioning that way because there are requirements on recipients that they work or be in some other training program in order to receive benefits. Some of that is waived for people who have very small children, who have dependents at home that they have to take care of, but those time limits don't completely go away. Nor is the requirement that you should be fully engaged in work or the idea that you are looking for work. So a big part of receiving SNAP is showing that you are continuing to look for work and you are trying to better yourself so you can get off of the program. And again, we run into this interesting dilemma of you cannot leave your house to seek work, let alone have work, if you do not have adequate childcare.   So one of the things that MAZON has been very concerned about and tried to lift up is that there is this undeniable relationship between the need for subsidized childcare and the need for SNAP, that these two things are very connected. And in trying to lift up that connection, we hope that we could actually make a real policy connection between the two.   Thank you, Abby. I know you're trained in law, and as a lawyer with a background in women's rights, how does this fit together with the work that you're doing now to end hunger?   So first of all, when you're an advocate, those skills never leave you. In fact, in my family, I was sort of infamously dubbed, even as a small child, to be a person who was very consumed by what was fair and what was not. And trying to argue vociferously for myself about staying up late and eating whatever I wanted. So I've seen myself as a person who had made a commitment a long time ago to working for justice for those who I felt were far more vulnerable in America than others. And there is certainly, as we've discussed, this very strong relationship between the work I did around women's rights, and those who are struggling with hunger in America. When we think about the feminization of poverty, this is not just a slogan. This is a description of what poverty looks like in America. It is dominated by women, and in many cases, women and their children. So it's not that I strayed that far, in my view. I have moved to a different set of issues that has a tighter focus, if you will.   I'm very impressed with the work that MAZON does. And this is actually a nice transition to the final question. So why don't we end on an optimistic note? So what are you most excited about or hopeful for in the coming year?   So this is what I see, which is that the pandemic did something that advocates have not been able to do for generations. And that is it put the issue of those struggling with food insecurity in America on the front page. This has never been a focus of this country. And the stunning images that we can see that dramatically demonstrated that the charitable network in this country is not equipped to respond to the tens of millions of people who need to eat three meals a day, every day. They're not set up for that. It wasn't what the design was. The purpose of government is to step in and be our community writ large in that respect, that we look at government in much the same way as we've now heard our President articulate it, that the government is there to serve, support, and help people.   At MAZON, because Jewish values tell us that very same thing, we've seen this moment where we have not only the need, this incredible challenge facing all of us, but we have opportunity in the administration that embraces the idea that, yes, we as a country are responsible for all of those in our country. And we have political and public will that is saying that, "Oh my God, this is truly an issue. "This is something that we can't pretend "happens in countries far away, it is happening here." And then sadly, I think that those numbers of people who now find themselves food insecure include people who never saw themselves in any way financially vulnerable, that they were people who gave to charity, they didn't have to rely on it. And at MAZON, we shy away from thinking about this as issues of charity for just those reasons because we think of it as justice, which is what the Hebrew word for charity, it's tzedakah and it is about justice. That word translates to being justice. So this is about recognizing that all of us are either in need or could be in need. And then as a community, as a country, our job is to respond without judgment, to give people dignity and respect, but also to treat them with compassion.   Bio:   Abby J. Leibman has been President & CEO at MAZON: A Jewish Response to Hunger since 2011. Prior to her current tenure, Ms. Leibman had a consulting practice to assist social justice organizations, businesses, and public institutions meet the challenges of growth and change, including leadership development, managing diversity, and implementing strategies to respond to discrimination. Among her clients, Ms. Leibman worked with some of California's most innovative organizations, including Jewish World Watch, Food Forward, L.A.'s BEST, UCLA Hillel, Valley Beth Shalom Synagogue, the Jewish Federation Council of Greater Los Angeles and the Progressive Jewish Alliance (now Bend the Arc).  

The term urban agriculture is becoming more familiar, but relatively few people know how this works on the ground in real world settings, and can fully appreciate the promise it has for the future. Our guest, Rashid Nuri, is the ideal person to explain. In 2006, Nuri founded the Truly Living Well Center in Atlanta to realize a vision for community food, sovereignty, and equity. This urban Ag organization grows tons of chemical-free, nutritious food, provides jobs, and works to educate communities.   Interview Summary   Now that you're the CEO of the Nuri Group, an organization that advocates broadly for urban agriculture at the local, regional, and national levels, you're working to expand equitable access to the tools for success in urban centers through education, and funding partnerships and appropriate regulations for urban agriculture. You're doing really amazing work. You had what you call a burning bush revelation while you were a student at Harvard University. Can you tell us about that and how you came to work in urban agriculture?     Oh, yes. So I'm a child of the '60s, and we were talking about nation-building. Black Power nation-building, and I was trying to decide what kind of work that I wanted to do. My studies as an undergraduate was in national development, how you build countries. I studied the men and women who created the post-colonial world. I was sitting in the library at Harvard, was reading a book by Tom Mboya. I'd already had an interest in health and nutrition. In his book, he said, "With all the technology available in the world today, "there's no reason we could not chemically synthesize "enough food to feed all the people." And that was a shock to me because it was all those chemicals that are killing folk. It was the word of God in my ear that said, "Learn everything about food from the seed to the table "to do it experientially." So that's the work that I am engaged in for all these many years. It's taken me around the world. I've been able to examine local food economies around the world. I've worked in 36 countries and all over the United States.   It's stunning that you've worked in so many countries around the world. So how has your experience outside the U.S. informed the work that you're doing here?   Humankind used to live within walking distance of where their food was produced and this still exists, to a large extent. If you go to Asia and Africa, you will find people can walk to where their food is, but there's this movement towards the cities. The United States now, over 80%, 82% of the people live in urban areas, metropolitan areas. Worldwide, it's predicted by 2050 that 65, 70% of the world's population will be urban. So to see how local food economies actually work the interaction, the sub-text for Truly Living Well was "We grow food, we grow people, we grow community," and to be able to see how this happens around the world has informed the work that I have done in the United States and specifically in Atlanta.   So can you share with us, please, your sense of what urban agriculture is?   I do make a distinction between urban farming and urban agriculture. Urban agriculture is the rubric, the umbrella that covers all of it. You have to be concerned about food, clothing, and shelter. It's not just the growing of food it's not addressing the needs of people in areas where there is food apartheid, is the term that's being introduced now. The USDA calls it food deserts; it's much greater than that. We have to be concerned we live in the richest nation in the entire history of the world, but you walk down the streets, you find people who are homeless, people who don't have medical care, the education system in this country is falling apart. All of these things come under the same rubric and I proffer that urban ag does not solve all these problems but it offers a solution, a solution and approach to addressing many of the problems that we have in the community. Each of the farms that we have built, we've provided employment, and twice now I've built the largest farm in metropolitan Atlanta. We provide employment, we've cleaned up drug and sex trades in the neighborhood, real estate property values go up. We create safe places for people to be able to come and commune with one another, get to know one another. So urban agriculture to me is all those issues that I've just described.   So let's talk a little bit more, if we could, about the farm that you just mentioned in Atlanta. What's its size? What do you grow there, and who does the food go to?   The first farm I built was six acres and we had to move the farm to a better site and we literally took all of the soil and moved it to the new site in dump trucks. And we also took 125 fruit trees, one at a time, and transplanted them in the new site. We move Paradise and they literally put in a parking lot, literally. You asked what we grow. So we have all kind of fruit trees examples of fruits is many varieties of each, apples, pears, peaches, plums, pomegranates, pawpaw, all the vegetables, seasonal vegetables, greens, tomatoes, peppers, cucumbers, squash, sweet potatoes, onions, garlic, turnips, beets, carrots, everything, just depends on the season.   Now, I'm very pleased to see that second part of your question was, "Who gets the food?" And that's the fun part! When it first started, there was one point we were in seven of the Top 12-rated restaurants in Atlanta. And that's a very good way for young people who are just getting into business and get started. So many of these restaurants have farm to table menus and advertising the fresh food there. And that's an indicator of the progress that this work I've been engaged in has made. But at the end of my tenure, that food was getting into the stomachs of the people who really needed it, and I think that that is a significant thing. We had CSA, consumer-supported agriculture, where people would come out to the farms to pick up the food. When I started, it was hard to find a farmers' market. Now you can get one just about any day of the week around town. So it became necessary for us to participate in the farmers' markets.   You mentioned something really fascinating – that you moved the soil from the original location to where the farm is now. Why do that?   All wealth, all health, all life begins and ends with the soil. That's the most important thing. Too many people, when they engage in agriculture, think they're trying to grow the plants. What you really need to do is grow the soil. You want to build the soil. And I'd spent 5 1/2 years building that soil down in the old Fourth Ward here in Atlanta and there was no way in the world I was going to leave that. The mantra as, I began my work in Atlanta and teaching, my mantra was compost, compost, compost. Commercial agriculture looks upon the dirt as a receptacle for the roots of the plant rather than as the source of the nutrients. Their scientists think they know more than God does and how to produce this stuff. All my work is an attempt to emulate nature.   When you and I were chatting, you mentioned the links you see between regenerative agriculture and urban agriculture. And I know the people who do regenerative agriculture care deeply about the health of the soil, but could you explain those links?   Everything begins and ends with the soil. Urban agriculture, we're talking about the location where we grow. The clearest indication of the quality of your soil as well as the first livestock you should have on the farm is earthworm. You don't see any worms in your soil, that soil is dead. All the mycelium, rolypolies, and millipedes, centipedes, these are the things you want to have in your soil. The work we are doing, the demonstration of this work is pre-industrial and regenerative. That is what we're trying to do. So there is no contradiction between regenerative agriculture and urban agriculture. You're really trying to accomplish the same end. And I think that the young people today have picked up this term, when in fact that's the original way that food was grown. This is my definition of organic; it's whole and complete. You go back and look at agriculture, all the waste went back into the soil. Animal waste, human waste, all of it went back into the soil to replenish it so they could grow more food.   Let's talk about the role of urban agriculture in feeding people in cities. So you mentioned when we began about the percentage of people in the world who live in urban areas, so what role do you see for urban agriculture in this area? Well, substantive. Atlanta is the greenest city in America by virtue of trees and open space. I travel around the country and looking at other areas, there's plenty of land. We can grow all the fruits and vegetables, not meats and grains, but all the fruits and vegetables. There's plenty of land to be able to produce that in the metropolitan area, suburban, peri-urban, whatever term you want to put on the name of the area.   What sort of policy changes do you think could be made to help this move along?   Ah, thank you, Professor, that's a wonderful segue to what it is I'm working on now. America is the greatest agricultural producing country in the entire history of the world. No one's ever produced more food. It's gone backwards because we're putting all these chemicals out here now instead of actually growing food. And the genesis for this leap in ag production came from four bills that were passed within 48 days by Abraham Lincoln, back in 1862. First was the establishment of the Department of Agriculture, he called it the People's Department, which was the first subject matter department of government. And by subject matter I mean, now we have a department of energy, transportation, housing and urban development, health, we have a labor department, you have all these different departments. Back then, they had the Secretary of State, Treasury, and War. These were the principle departments. The second bill was the Homestead Act. The American people paid for folk to come over to the Midwest to homestead. They gave them free land, gave them subsidies for that land, helped them to pay for the land with just the caveat that they had to stay there and do some production. Then you had the Moral Act. All of these have had many different iterations but the Land Grant College Act provided money, land to build colleges, universities to support the agriculture. This is where the extension agents from, this is where the research is done. Big Ag does no research. When I started in this business, it took 12 to 14 weeks to grow a broiler. Now they get it done in six, and it was not the chicken companies that did the research to get this done. This came out of the university, it was subsidized by the United States' citizens. So much of our vegetables all over the country are grown in California. California has no water, at all. It's all imported, which is paid for by the taxpayers. It also promulgated the Railroad Act 1862. There's a whole lot of scandals that were around it, but the equipment that was made out of steel had to be brought from the East.   Point is, I would like us to see now a new modern version of the Homestead Act to support small farms and urban agriculture. That is the policy change. Now you can get elements of this, things that the NRCS as a department puts up hoop houses in urban areas, they got small farms and beginner ranchers' grants that you can get loans from the department, but there's not a comprehensive program to deal with creating an urban infrastructure. Now, Tulsi Gabbard out of Hawaii has just introduced a bill. I think it's HR 25-66, this is just getting started, to provide some support for urban agriculture, and that's the horse that I want to hitch my wagon to. We need to come up with an urban, modern Homestead Act.   Bio:   Rashid Nuri had a powerful “burning bush” revelation while a student at Harvard. The experience set him on a global food odyssey, managing agricultural operations throughout the U.S. and 35 countries in Europe, Asia, and Africa. Rashid saw, up close, the abuses and inefficiencies of what he calls Big Ag. His vision of community food sovereignty and food equity emerged with full clarity. He brought that vision to Atlanta in 2006, founding Truly Living Well Center for Natural Urban Agriculture (TLW). TLW became Atlanta's premier urban agricultural organization, growing tons of chemical-free, nutritious food, providing jobs, and educating communities about food, nutrition, and self-sufficiency. Now as the CEO of The Nuri Group, Rashid is working to expand equitable access to the tools for success in urban centers through education, funding, partnerships and appropriate regulations for urban agriculture.  

American Indians and Alaska natives face challenging economic, environmental, and political conditions that are in many ways similar to those experienced in developing countries. About 37%, for example, of Navajo or Dine people live in poverty. Access to preventive services such as cancer screening, immunizations, and early detection is often limited. And patients must travel long distances to obtain medical services. The situation is made worse by the lack of access to healthy foods. As a result, the life expectancy for American Indians is about six years shorter than that for the general population. Additionally, American Indians suffer disproportionately high rates of obesity, diabetes, heart disease, mental illness, and substance abuse. Today, we are speaking with two impressive people working to change that, Dr. Sonya Shin and Kymie Thomas. They run the Navajo Nation Community Outreach and Patient Empowerment or COPE Program. This is a community-based outreach and food security program made possible through a formal collaboration between Brigham and Women's Health in Boston, Tribal Leadership and Indian Health Services to address health disparities in the Navajo Nation.   Interview Summary   So Sonya, let me begin with you. As a physician at Brigham and Women's Hospital and a professor at the Harvard School of Medicine, can you explain why you founded the COPE Program and the impact that it's having?   I started off my work abroad doing global health. And as I began to learn about how to partner with communities to address health issues, I became really interested in turning my attention toward some of the issues that are facing our communities here in the United States. So we were just really excited and honored that about 10 years ago we were invited to partner with Navajo Nation. The idea was to really work in solidarity with the tribal leadership, with community partners, and health care providers to address some of the health disparities that you described before.   Kymie, I'd like to ask you as a member of the Navajo Nation, and the health professional and coordinator of the program, you're in a unique position to help our leaders understand the experience of living in a food desert on a reservation. Can you describe more about this?   I grew up on the Navajo reservation, which is a larger reservation. It encompasses three states, New Mexico, Utah, and Arizona. The distance and traveling between the communities and to the nearest towns is about two hours. So within these communities, there's a limited amount of grocery stores. People purchase foods in the convenience stores. And as you are all aware, most of the convenience stores typically only have processed foods and nutrient dense foods. And they offer little to very little variety when it comes to fruits and vegetables. So with families living in a remote area, the delivery of these fruits and vegetables to these stores drives the cost of transportation to these families. So when they go in to purchase their food, they're looking at foods that will last longer for their families. And some of the foods there aren't very great quality. So most of the families have to travel more than two hours to be able to obtain these foods. My family didn't have electricity until just recently. So in my family, we would have to travel into Gallup, which is for us a 45-minute drive. And we wouldn't be able to purchase frozen fruits or vegetables, mainly fresh ones, but even then it wouldn't last very long. So my parents would have to purchase foods that would last our family longer. So like potatoes and canned meats because you typically don't need refrigeration for that type of food. And so I think for the people who live on the reservation, a pressing issue to not be able to purchase these healthy foods that we tell them to consume when they don't have access to plumbing or electricity. So a lot of those factors combined really play a huge part in some of the challenges that our families face in obtaining healthy foods in a food desert.   So thank you for that description. Sonya, let me ask you, what is the COPE Program all about, and how does it go about trying to close these gaps for proper nutrition and while being centrally located in what's this food desert that Kymie just described?   When we started the program, we weren't actually thinking about addressing food insecurity. I was thinking about, okay, I'm a doctor. You know, how do I address diabetes? How are we going to be dealing with the rising rates of childhood obesity? But it became quickly apparent that a patient of mine with diabetes doesn't need to be told that they're supposed to eat fresher fruits and vegetables. They know this. And so we quickly became aware that in order to start to move the needle around some of these health issues, we were going to have to shift our focus from just trying to increase access to health care to also increasing access to healthy foods and actually making it possible for patients to make these changes that they want to make. We thought about it for some time and we listened to a lot of different partners. And what we heard is that on the one hand, really important to think about these individual families that are living deep in the reservation, oftentimes with very few options, but also to think about how do we create an approach that doesn't just push all of the resources out to the border towns. So creating ways for people to travel outside of the reservation and spend their money, say, at a neighboring grocery store, it doesn't actually change the actual status of the community on Navajo.   So we decided that the Fruit and Vegetable Prescription Program that Kymie runs might be an interesting approach for several reasons. One is that healthcare providers want to do something. When I see a patient in clinic and I know that they often don't have healthy foods, especially after the first week of the month when they have fewer options, no electricity, et cetera, I want to be able to offer that family something. So engaging healthcare providers as implementers seemed very appealing. And then second, the idea of being able to use the vouchers that families receive to also kind of infuse economic stimulation to the local food system and the local economy was very appealing because that meant that over time, hopefully we could actually have a lasting impact on a more kind of thriving and robust food system. You know, I would invite Kymie to describe a little bit more of that Fruit and Vegetable Prescription Program or FVRx as we call it. To us it seemed like a very interesting model for a cross-sectoral approach to address both the food system on Navajo Nation, and also health disparities.   Kymie, please do tell us more about the program.   We work closely with the providers addressing a family that's in need. So finding that area where there is a need and locating those families and being able to work closely with our store team here in the organization to ensure that our partnering stores where sites are able to redeem vouchers, that they are also fully equipped with a wholesome variety of fruits and vegetables to be able to meet the selection from our voucher program, and not only for our participants, but basically anyone who comes into the stores to purchase food. You know, when they see that there is a bigger variety of fruits and vegetables, they're more than likely going to be able to purchase that as opposed to just bananas and oranges that convenience stores normally have. And then also creating partnerships with our local growers so that families are aware that they can find vendors in their communities who sell locally grown produce. And another big emphasis is also incorporating more of our traditional foods back into our diets. So, you know, corn, fresh fruits, and vegetables like carrots, things that we have normally eaten just re-introducing that back into the diet as an indigenous community.   Sonya, is it too early to know what kind of impact this is having?   Well, we're starting to generate impact. And I can describe some of the data that we're seeing. We're really interested in real world results as opposed to a clinical trial, but what we are seeing are, I think, pretty promising. So to give you a sense, we did ask that all of the clinics prioritize families with young kids. So either families with a pregnant mom or with a child that's under age six. And we did that because we felt that the program would have the greatest impact on the health outcomes of that specific family. If we targeted really early in the life course of the child, it's an opportunity where there's a lot of positive and motivation for change, and families are very excited to make changes for their children. So that said, when we've looked at the families, not surprisingly, three quarters of the families are actually food insecure and that's actually similar to other data that we've seen published about Navajo Nation. And after the six-month program, we've definitely been able to demonstrate that fruit and vegetable consumption is increasing among both the kids and the pregnant moms.    I think one of the things that's most exciting of the data that we've seen is the change in the body mass index among the children. So we know that childhood obesity is associated with food insecurity. So it's not surprising that we're facing high rate of childhood obesity, as you mentioned before, Kelly. Among children who are enrolled with an initial weight that classifies them as overweight or obese, actually 38% of them achieved a healthy weight after six months. And I'm not a pediatrician, but I've been told by my colleagues who are running the program, that for them, it's really one of the most impactful programs that they've had the opportunity to implement with their families. The other thing that we're kind of interested in and we're just starting to see some of this data now is the spillover effect that Kymie mentioned.   So a family can participate in the program for six months, but what we're really after is changing the options out there at the community level for those families beyond the program. And then for all of the community members. So if there's a small little convenience store or trading post, that's really the only thing around for like say 60 miles, we want to change the variety, the options, the quality of the produce that's available in those stores by driving up demand, and therefore bringing up supply. So we've actually looked at shoppers that are leaving these stores and compared stores that are part of this program to stores that are not participating. We're seeing that just generic shoppers, so these aren't people who are actually enrolled in the program, are actually purchasing more fruits and vegetables from participating stores. So our hope is that over time, if we can start to change the food environment at the community level, that we could actually have an even greater impact at the population level on some of these health issues.   You know, the number that you gave, two, or three quarters, rather, of households being food insecure is incredibly discouraging, but it's really nice that you have such encouraging findings. It's very impressive what you're reporting so far. Let me ask you both a question. Sometimes relationships between organizations outside a community, like a university, and what goes on in the community, it doesn't work very well or it's very challenging to work through issues of trust and things like that. I'm curious from both of your points of view, how did you go about establishing trust, developing working relationships, creating a program that the community would actually embrace?   Having Navajo representation within the organization to help deliver the program has been really helpful. So I think with a lot of our families, it's just reassuring to them seeing someone that is the same as them, you know, me being Navajo also, they're comfortable with us coming out to families. And I think just us understanding and having that connection really has allowed the families to become more comfortable with the providers and the outside personnel. And there are some areas where a lot of the health professionals that make it up are also Native American or specifically Navajo. Just having someone similar to them and knowing, understanding where they're coming from really helps them to embrace the fact that we are here to help them. We only want for them to be healthier and that we are hoping to establish a healthier nation. We are trying to change these health disparities. We are not necessarily trying to change their whole lifestyle, but more of just incorporating more fruits and vegetables, slower steps.   And Sonya, from your point of view, how do you see this process playing out and issues like trust working?   I'm glad you bring it up. And I appreciate Kymie's comments because I think it's really key to any meaningful work when serving other communities. And I think Kymie's testament to being a member of the Navajo Nation and being able to, not only build that trust as a frontline staff, but also given that opportunity to advance her own career and have the option of coming back and working in public health has been one of the important achievements of our organization.   I can say from my own standpoint as a provider and as somebody who is not from the community. With patients, it took me about four years to actually get any trust with the patients that I see in clinic because they're so used to having providers come for about three years, which is about how long it takes to pay off your loans, and then to just cycle on out. And so I think there's this important role of just being present, and constant, and really listening.   Most of our programs took a long time to germinate because we had to really just spend a fair amount of time listening to others and make sure that we were finding an approach or a strategy or a program that would respond to those needs and not actually become interventions that sort of circumvent or undermine other movements that are happening. You know, we spent a lot of time thinking about like, well, who's in the food space? Who's doing this kind of work? How can we not be the frontline providers, but how can we be the folks who are kind of infusing additional resources or ideas to build the capacity among folks who are already here in the community? I think that's been a really important approach that we've taken over time. And it's taken us 10 years to get this far. And, you know, I hope that the fact that we do have a fair amount of trust among providers and also with the Navajo Nation leadership with whom we consult quite frequently, is kind of a testament to that approach of partnership.   Well, thank you. Kymie, I'd like to come back to you in just a moment and ask you about barriers that you encountered while the program was being implemented, but before I get to that, Sonya, do you believe that this is a model program that can be replicated elsewhere? And are you two working to get this program to other communities?   Yeah, I think from the very beginning, we were interested in choosing something that had the potential to be replicable to other Indigenous communities. And I should mention that FVRx, this Fruit and Vegetable Prescription Program is not unique. Like we're not the only ones doing it. There are many different communities across the United States that offer prescription produce within healthcare settings. To our knowledge, this might be the only one being offered in a Native community, but from the very beginning, we've really tried to think about, okay, how can we create materials, generate evidence, think about flexibility that will allow the program if it's successful to then be transmitted to other indigenous communities? And I know Kymie's received a lot of interest and inquiries from other Tribes. I think the key take-home for us has been that every community has different strengths and different needs. And we've even seen that across Navajo. If we have 12 different clinics that are running the program, there's a lot of heterogeneity of the program because each clinic has different teams that want to implement. They have different priorities, and they also have different gaps. So I think we've really tried to create a program that has parameters that are core, but has a lot of breathing room for flexibility and adaptation, so that our hope is it will be easier for other communities to take the model and then to say, "Okay, well, what's going to work in our community? "What's my priority here? "Who's the team that I envision doing this work?" So that's a future learning step for us too.   So Kymie, what are some of the barriers that you and your team encountered as you were implementing the program?   So as we are going across the reservation and implementing the program, we have started to notice a lot of good indicators of the work that we are doing. For instance, no bandwidth. Right now, we are a two-person team right now, and we are expanding to three, hopefully in the future. But, you know, with the increase in popularity of the program across the reservation, it's hard to keep up with that demand. So finding the bandwidth to be able to keep the program and quality of the program going, it's been really challenging. But it's good that the program is growing and that we are needing extra hands.   And then also, just finding compatible platforms that work for everyone. So what might work here on a border town, because we have no internet capability, might not work for another clinic or another community health team that's based six hours away, more in the middle of the reservation. So I think just finding compatible platforms to be able to communicate with everybody has been pretty difficult. And then, as the program is expanding, we are coming across other barriers, but they're all a pretty good indicator of the growth that the program is seeing overall.   Bios:   Dr. Sonya Shin, is a physician in the Division of Global Health Equity at Brigham and Woman's Hospital and professor at Harvard School of Medicine. Her research and clinical experience has focused on relieving health issues among underserved populations. She has been working in Navajo Nation since 2009 and is the executive director and founder of Community Outreach and Patient Empowerment (COPE), a non-profit and Partners In Health sister organization that aims to eliminate health disparities and improve the wellbeing of American Indians and Alaska Natives through community-based outreach and food security initiatives. Kymie Thomas is a member of the Navajo Nation, a coordinator for the COPE FVRx program and an aspiring Public Health professional. She earned a degree in Health Sciences from Sheridan College, and have 4 years' experience working within the Public Health sector. As the Fruit and Vegetable Prescription Program Specialist for the COPE FVRx Program her work has allowed the COPE Program to help increase access to healthy foods for Navajo families, and improve health outcomes in various Navajo communities that are affected by diet related diseases.  

If you go to the website of an organization called GOODR, at goodr.co, you will be rewarded with inspiration to be sure but you'll also find some startling information. While one in seven Americans is food insecure, 72 billion pounds of edible food goes to landfills each year and $218 billion is spent growing, transporting and disposing this food. You will also learn from our guest, Jasmine Crowe and I quote, hunger is not an issue of scarcity, it is a matter of logistics. Jasmine Crowe founded the tech-enabled sustainable food waste management company, GOODR. The ingenious work she has done in Atlanta, which simultaneously addresses food waste and food insecurity, has received national and global attention and is featured in a terrific TED Talk that Jasmine's given.   Interview Summary   What is GOODR and what inspired you to begin this effort?   So GOODR is a sustainable food waste management company. Essentially, we look at ourselves as any waste management company would, a waste management, a republic solid but our focus is on food and we back everything that we do in technology. And I was actually inspired to start GOODR through own personal experiences. I started feeding members of our homeless communities in 2013 and that was really my first exposure to actually fighting hunger on a personal level. So cooking meals for about three to 500 people every two weeks for my kitchen. But I think what really inspired me to get started was when I realized that some of my personal family and friends were either currently struggling with hunger or had struggled with hunger and it opened my eyes to see that hunger just didn't discriminate. Here were friends of mine that I knew were college educated, well-traveled, had led really great careers but just ran into some struggling periods where food became an option and not a necessity. And when I saw that and saw how much food was going to waste, I decided that I wanted to really give my all into solving this problem.   Well, that's impressive that you were cooking meals for so many people. Paint us a picture if you will of what day-to-day life is like for people who struggle with food insecurity.   Yes, so you said it, Kelly. You're going deal with about 42 million people on an annual basis that are living food insecure. And so what that means is that every night, they're going to go to bed hungry, often wake up the next morning, still hungry and not knowing when or where that next meal is coming from. And so when you look at this, you're looking at about 14 million children, 7 million seniors that are dealing with hunger every single month. And when I think of the fact that they have to make these critical choices, especially my senior citizens who really, that's where my heart string lately in doing this work has been greatly pulled towards, because many seniors are receiving just $16 a month in SNAP benefits and they have to make that choice. Hey, am I going to pay for my prescriptions, or am I going to pay for food? And often, so many of them choose prescriptions because they believe that's what's going to help them live longer. But when I'll sit and talk to the seniors and they'll show me their prescriptions, so many of them require them to be taken with food. And so what I see them doing is they're eating crackers. They're eating tuna. It's not a good day for any of them and when they get free food, they clamor to different events and workshops in their senior homes, because that's going to be the only time that they eat. With children, you have kids that are going to get free breakfast and lunch every day at school but what does that mean for them on the weekends? And what you see is that these kids are constantly playing catch-up. So if they get free breakfast, that's great. But if they didn't get free dinner last night or dinner at all, now what you do is you have this breakfast that's replacing the dinner that they didn't get, the lunch that's replacing the breakfast that they didn't get and now you have children that are sitting in class. They can't focus on learning because they're hungry still and no teacher can teach through hunger. You know, I can't tell you how many parents I've met who have said, I go hungry just so my kids can eat. And those are just some of the struggles but these are working people, or people who have worked their entire lives or children of parents that are working that are struggling. It's not just people that are homeless, which is where I started and where I was wrong.   It's really heartbreaking to hear that these stories occur at all in a nation that has enough food and let's get to that now. When you said you founded a waste management company, most people don't associate waste management with addressing food insecurity. So tell me more about what GOODR does.   We basically work with businesses. We inventory everything it is that they sell. So people will think of us almost as like an Instacart or Uber Eats, if you will, in reverse. So we know what the business sells, what their retail costs are and at the end of the night, when they have surplus food that would otherwise go to waste, they can use our mobile app or our web portal to request a pickup. And we created a very easy user experience which allows them to scan items out or click on items and tell us the quantity and our platform calculates the weight value, as well as the tax value of that donation. They can't request pickup. We deploy our network of logistics partners. We get that food delivered very fast to a nonprofit that's within a five to 10 mile max radius of where that business is and that nonprofit receives it. They sign for it like they would a UPS package. A donation letter is then placed into our customer's dashboard. And so that's where we've started with the GOODR hunger. And now we are rolling out to animal feed as well as compost, because we believe that we want to solve food waste just as badly as we want to solve hunger and so while we're concentrating on what's edible now, our focus at whole is to be a full service food waste management company that can go into any food service business and say, we will take care of all your food waste, thus eliminating the need for their daily waste management service.   So is it financially sustainable or financially feasible for say, a restaurant to do this? Because they might pay you to pick up the food and that makes your business sustainable but then they don't have to pay to have the waste disposed of in the traditional ways. Is that the way it works?   That's the way we're wanting it to work. So once we have all of the services in the order where we're helping with compost, animal feed even anaerobic digestion, that is the vision. I mean, it's very much sustainable for them because the thing is Kelly, if you look at it, they're already paying to throw the food away, so that we're not introducing a service that's so foreign to them. Right now, they're just paying a waste management company to throw it away but once they spend that dollar, the only thing that they could do is then write it off as a business expense but with GOODR, not only could they write us off as a business expense if they choose to, now that dollar tells a different story. Now they have a sustainability story that they can tell their constituents. We are improving our carbon footprint by reducing the food waste that our company produces on a daily basis, getting food to people in need becomes a corporate social responsibility story. And then they know everything that they donate that's edible, they get a tax deduction for it. So in essence, we're actually improving their bottom line. So I look at it as a triple win and a very big value add that they once did not have.   I'm glad you mentioned the environmental benefits of this, because many people may not realize that when food gets discarded and goes to landfills, it contributes a lot to climate change. So I'm assuming that's what you mean by the environmental consequence?   Exactly. I think a lot of people don't realize that.   So give us an example. Take a restaurant, or a food business or something like that and paint a picture of what they might have left over at the end of the day and who picks it up, actually and then where it gets delivered to?   I'll use the Atlanta Airport. That's one of our first key signature clients. Our do-gooders are in the airport six days a week. We go restaurant-to-restaurant, so you just imagine a food court, if you will, where you have all of these restaurants connected to each other. They are entering their food for pickup. Our do-gooders enter the airport right at closing time, so we're capturing the food at the peak freshness. We're getting it from each of those restaurants. It goes into our packaging, as well as our insulated bags. We have a refrigerated truck that drives right on the tarmac and then it's delivered to nonprofits every single night. So that's kind of how it works at the airport. We actually do start to help the customers reduce their waste, which is something that I do love about GOODR but it's never going to go to zero. And so we've seen that over the last year working with the airport. For example Einstein's Bagels was one of our airport customers and when we first got started with them, we were picking up anywhere from three to 400 bagels a night because their standard of bagel freshness is fresh bagels every three hours. But once we were able to show them how many bagels they were wasting, they started to reduce their production. And so now we pick up from Einstein's on average anywhere from 40 to 80 bagels per night but we're still there to capture all of it. And so if they didn't know how much they were producing and how much they were wasting, they would still continue to overproduce. And so that's part of what that technology and the data that we collect around this waste does. We're going to pick up sandwiches and salads and meals that weren't sold. So that's what you're going to see getting picked up from an airport. At a customer like Chick-fil-A, you may see all of their salads, all of their wraps, all of their fruit cups and chicken sandwiches and chicken tenders that were prepared, maybe for drive-through or fast food quick service. Someone comes in and gets it, it just wasn't sold. And so those are kind of the items that you're going to see when you take it to the convention center level. You could see thousands of pounds of food, thousands of pounds of produce. It really just depends on what that show is that's taking place but the food that we've seen has been everything from filet mignon to apples.   I fly in and out of the Atlanta Airport a lot and that is a massive airport with an awful lot of food businesses. So I can only imagine the scale of what you're talking about. In addition to the place of serving food at the airport, what are some of the other kinds of businesses that you work with?   So we work with a lot of corporates. So we work with a lot of corporate cafeterias, SAP, MetLife, and Warner Media Group. So those are another kind of client vertical for us. We are beginning to work with colleges and universities, so we're really excited about that and we're onboarding grocery stores as well. So we have several different verticals that we work with within. But if you think about it, Kelly, food exists everywhere. So where we're really coming in now is just becoming a conduit to connect these businesses with all of this surplus, to people with me.   How far away from the place the food gets collected can you distribute food? And I'm thinking particularly about needs in rural areas. Would it ever be feasible to get food out to people who are outside of the city where the food's being cooked?   I think that's a great question and that's something that really keeps me up at night because on a personal level, people email me. I get Facebook messages, I get LinkedIn messages. You wouldn't believe it. And I hear from people in rural communities that are saying, ‘Hey, you know I'm in Macon, Georgia, I'm in Corpus Christi, Texas. Is there any way that you can get food to me?' And so that's really what's been having my brain spinning, where we are looking at entering this market without being too divulged in where we're trying to go, is as we start working with more grocery stores, we are looking at similar to meal kits, getting food to people in need on next day delivery through say a UPS, where we would get food boxes but that were filled with enough to make real meals. I mean, that's the difference in what you're seeing in a traditional food bank or a food pantry today. I would encourage anybody to go and volunteer at one because I did it myself and I couldn't believe the food that they were just giving people that wasn't going to make any real substantive meal for them or their families but would have lines of people just to have something in their house. And so with GOODR, I'm really concentrating on what does it take to sustainably package food to get to people next day delivery, right to their door. And so that's how I look at the opportunity to solve within rural communities. We are also looking at the expansion of the current franchise model with customers like a Chick-fil-A that are in a lot of rural communities. What does it look like to get food to people in these rural communities from our current customer footprint? We think that there's a big opportunity there.   Are there ever nutrition judgment calls you have to make with the food that you're collecting and who it goes to?   Yes. So we're using a lot of technology machine learning around that space to understand what kind of food we're getting to people. So we brought in a nutritionist and so we're wanting to make smarter decisions. If we say, get a nonprofit Chick-fil-A on a Monday we would want to try and get them a corporate kitchen, cafeteria food, maybe on a Wednesday, if they get another delivery from us. Or like a Sweetgreen, something that's just healthier. So we are trying to make sure that we're not sending them the same kind of food that is maybe considered unhealthy. We're focused on balanced nutrition across the board.   And what are some of the biggest challenges you face as you go forward?   I think the biggest challenge is still getting people past that fear of if I donate the food and someone gets sick, I'm going to get sued. That's a big part of it. We have to lose the fear in the hunger fight. GOODR comes in, we provide the supplies. We provide the liability insurance. You have the Good Samaritan Act. We have agreements in place with the nonprofits. So we've really covered so many of those bases but we still have people that for all intents and purposes are just afraid because they're living in the old guard, in an old mindset of someone's going to get sued. But when they think about it, they do this every single day. They're sending food that people pay for in a car with somebody to someone's house via Door Dash, Grubhub, Uber Eats and no-one's worried about someone getting sick in that route. So we need to stop being afraid of making sure that people eat, because that's when they really get sick, right? That's when they really could get gravely ill by not having food.   The other thing is, GOODR is a business, you know? I thought very hard when starting GOODR, would we be a nonprofit? And what I knew for sure is that if I was a nonprofit, I would spend all of my days really worried about donations instead of getting to the problem. And when you really want to solve hunger and you think that, hey, food banks have been around since 1970 and people are still hungry and the population of people going hungry continues to grow. You have to really look at it as a business, putting real infrastructure behind it. We want to pay our drivers and people that work for GOODR a fair living wage. And we really look at ourselves as a waste management company. Again, which a waste management company is not a nonprofit. This is a service, it's the right thing to do with donating the food that's edible. But as we start to expand it to these other services, businesses have to look at this as a true expense to get to their zero waste goals. And I think what we will see is a tipping point. Right now, hey, this could be foreign to a lot of people. They've never done it before. But what we are starting to see is a lot of shift in policy, where businesses are being required to recycle their organic waste and to donate their food that's edible. And you're seeing this happening all over France and Italy and here, even in the US, in Los Angeles County and Boston and Austin, Texas, these policy shifts are coming.   Bio   Jasmine Crowe, an HBCU alumna, is the founder and CEO of GOODR Co. Jasmine launched her first company BCG in 2011. Thru BCG she partnered with celebrities across the nation in a host of cause campaigns to ensure their star-power was being used for good. Lead by Jasmine, BCG hosted activations in more than 20 US cities and the UK, South Africa and Haiti and has collected and donated over three million items to causes worldwide and fed over 80,000 people through the Sunday Soul Homeless feeding initiative. Jasmine also served as the creator and executive producer of Change Makers a half hour docu-series profiling how celebrities use their star power for social change which premiered on Magic Johnson's network ASPIRE! In January of 2017, she launched Goodr, a sustainable food surplus management company that leverages technology to combat hunger and reduce waste. Today Goodr redirects surplus food from convention centers, airports, and businesses to people who are food insecure.  

Ever wonder how a groundbreaking, pioneering, and award-winning chef and cookbook author came to such a place? Today, we'll find out from Deborah Madison. After working at breakthrough restaurants Chez Panisse in Berkeley and Greens in San Francisco, Deborah Madison made her mark in Rome, opened Cafe Escalera in Santa Fe, and became a prolific writer of cookbooks and articles about foods for places like "Gourmet" magazine and "Food & Wine." Her latest book, which is entitled, "An Onion In My Pocket," is a memoir. It has been very positively reviewed in many places with terms like "beguiling, honest, and captivating." And in the words of Marion Nestle, a well-known figure in the food area, the book shows how the path that carried Deborah to become what Marian said is, "The consummate vegetarian cook and cookbook writer."   Interview Summary   So your book, "An Onion In My Pocket" - that's a really intriguing title. How did you come to that?   Well, there was an onion in my pocket one day. And I just was writing about it, maybe telling my editor about it, and she said, "Oh, we should use that for the title!" There was an onion in my pocket because I had been cooking with a friend and these onions were leftover from a pizza we were making. They were beautiful onions and I took it home with me. And then I went to Spanish class and it was in my pocket along with my pencils and papers and things like that. And I took it out, put it on the desk, and people started to laugh. And I thought, to me it's normal that I have an onion in my pocket or I could have anything in my pocket. I've even had a snake in my purse that I brought home once because it was going to eat gophers, which I really appreciate. So that's how that came about.   Wow, all kinds of interesting things show up in your pocket, in your purse. So in your book, you write about some of your other 14 cookbooks and what was involved in writing and publishing them. Which ones mean the most to you?   Well, I think Local Flavors does, Seasonal Food Desserts and above all, Vegetable Literacy. And they mean something to me because actually the first chant that we learned at Tassajara, which is the Zen monastery I was at was: 72 labors brought us this food. We should know how it comes to us. And all these books are indirectly about how food comes to us and the stories of food. And they're interesting to me and I'm still very interested in that question. So those are my favorites.   So Deborah you mentioned something that I find fascinating about the story of food. Does it seem to you like it does to me that more and more people are becoming interested in the story of their food, and do you think this is a positive trend?   Well, I feel like it's both positive and not so positive. I hope we're not going to lose what we've gained in variety, particularly of vegetables because it's been a long, long fight. You know 40 years ago there was nothing, there was really nothing to eat and now there's a lot. And yet people are going back to old things as vegetables become harder to get. I've even cooked corn dogs for my husband who requested them. And I thought, Oh really? I've never even had a corn dog. What is a corn dog? I had to go online to learn how to make one. I think that there's kind of a retrograde happening right now in the pandemic at the same time I think that people are interested in the story of their food and they have to be because it's disappearing.   As I look out there and I see more and more restaurants have a board on the wall that lists the farmers where the food comes from and you hear people talk about food miles or the environmental impact of the foods they're purchasing or consuming. And you know, people are interested in animal welfare or others are interested in some other issue of theirs, but when you put it all together it seems to me that the number of people care about these things has gone way up. And then I at least see that as a very positive trend. But I appreciate your thoughts on that.   I think it's a positive trend too. And I like it and I hope people really do what they say for here in New Mexico. People would say, "Oh, we use local food" and they'd order a pound of lettuce or something like that. And it would run out. But I think people are doing more. You can taste the difference. You can see the difference customers aren't stupid. You know, especially if they shop at farmer's markets there they're familiar. And if they have gardens and I think more and more people are gardening, at least judging by the seeds and how they're disappearing from companies who take breaks and fulfilling orders and that kind of thing. But I think you're right. I think there is more of a concern than there has been in the past.   So you write about what you call Kitchen Lessons things that you've learned often from customers. Can you share some example?   The one I was really interested in was 'Don't Apologize.' The example I used in the book was with a customer who said he loved the smoky flavor and the mushroom soup we had made. I know I knew there wasn't supposed to be a smokey flavor. So I just said, thank you very much because why make him feel terrible about misjudging or not recognizing that the solids have fallen to the bottom of the pot and were scorched. And that that's what he was tasting. So that was a lesson that I did learn very much from customers.   Other lessons I knew or I learned were to one eat in the dining room. Like a customer is very, very important as a way to getting to know your food treat everybody the same for sure you have to do that. And I mean I learned these lessons in the most painful ways possible. Marion Cunningham taught us a really good lesson when she said, "Debbie, dear do you not believe in salt?" And then she talked about salting food and how you should salt as you go, when you cook. Let's see be gracious always to everybody. You know, people would come into the kitchen and tell me that that was the best meal they'd had. And I'd wanna say, "you're kidding." "What do you eat normally?" You know, but I finally had to learn that their experience was very different from mine and that it was just important to say, "I'm so glad you enjoyed it," and actually mean it.   And the last lesson, wasn't so much a lesson but a hint of things to come, which was; know that the six months in the beginning will be the hardest but you will get to leave one day. And that did happen almost to the day. And I was reflecting upon that and thinking at the time, "Oh six months have gone by, I've made it, we've made it." And now Greens is over 40 years old. It's amazing.   Let's talk about that a little bit. So if you think back to those days when you worked at places like Greens and Chez Panisse, how are those or similar restaurants different today than they were back then? Certainly they're more popular and visible, but beyond that have things changed much within the restaurants?   Oh yes, I'm sure they have especially Chez Panisse because I never, ever could walk in and get a job like I did then. I just wanted to work there so badly and it made so much sense to me, their food made so much sense to me. And I don't think I would have been able to do that today for sure. Alice isn't there so much, like she was then and it wasn't some new greens for one is the dinners are all a carte menus. They're much more expensive. They're beautiful. And menus are printed on heavy paper stock. The waiters know the difference between espresso and espresso, which we didn't really understand, so much then we thought that coffee drink was to get you going. And it is, but it's not an express as espresso is pressed, things like that. So I think they are different but I think in some ways they're the same. Their commitments are the same. They're just many more restaurants that are doing that kind of thing too.   I scanned the titles of your books. Nine of the mentioned vegetables in the title but you say you're not a vegetarian, what is that?   Well, I just find it's too limiting. It's just too limiting. I think I'm probably a natural vegetarian and that's the food I really love to cook and eat. But if we are a nation meat eaters and I really think we are I feel it's important to know what that's about. And that's why I've been on the board of the Southwest Grass-fed Livestock Alliance twice. And if somebody, I know like my husband, for example wants meat and he was raised with meat, I'm happy to cook it for him. I don't like the limits of vegetarianism or any kind of food title. I don't really care to have a label attached to what I eat.   So given that you're so prominent and writing books for people who are vegetarian do you get any pushback yourself for the fact that you're not strictly vegetarian yourself?   That's the strange thing is I don't I have never gotten pushed back. Maybe people are horrified. I don't know, but in my book, 'Local Flavors' I actually did have 11 recipes that were for meat because meat was appearing in the market. And this was about the farmer's market movement across the United States. Nobody seemed to notice nobody commented. I don't know. It's odd. I haven't gotten pushback. On the contrary, I feel that people are sort of relieved with this book in a way. I'm not super strict about anything. I'm just not, I have a hard time being struck. Research about the vegetables I eat, I want high quality.   So what do you really think matters about food and how do you define the concept of nourishment?   Well, food that's cooked with a mind of kindness and generosity, care, thoughtfulness, maybe even simplicity. I think that that's, what's important as much more important than what is on the plate, whether there's a meat or not. And I actually did end the book with a lot of stories about meals I remembered and some of them had meat some of them didn't, but the point was that they were so generously given and prepared for me that I remembered them. Some of them happened quite a long time ago.   You know what's fascinating to hear you use words like generosity and kindness and describing how food can be given and received. How does that come through in the way say a restaurant can provide food to people or how families can do it? Cause it sounds like that's very important.   Well, it is. And I've always found that to be true at Chez Panisse. I love, for example, when people come into a restaurant they're welcomed with kindness with, "hello, can I help you?" And “Oh, you have a reservation with time and please follow me” and there's bread on the table. All those are something good. And that's a kind of food kindness that can be extended to strangers. I was writing in my book about more personal kinds of kindness, but not always. In fact, the first story I tell was a meal in Scotland that I had, and it really pointed me to my 'North star', which was about how food in season and in its place is the best food always. And you know, that was because a woman agreed to feed this older woman that I was traveling with and myself and we was really hungry and we sat and waited and we looked at the garden and we looked at the Lake and pretty soon she came in with a platter with the vegetables, from the garden and fish in the Lake. It was beautiful. It was really quite stunning   Bio Deborah Madison is an American chef, food writer and cooking teacher. She has been called an expert on vegetarian cooking and her gourmet repertoire showcases fresh garden produce. Her work also highlights Slow Food, local foods and farmers' markets. Madison grew up in Davis, California, and earned a bachelor's degree with high honors in sociology/city planning in 1968 from Cowell College at the University of California, Santa Cruz. She then cooked at Chez Panisse and was a student for eighteen years at the San Francisco Zen Center. She was the founding chef at Greens Restaurant in San Francisco which opened in 1979. She then cooked for a year at the American Academy in Rome, Italy. She has written for the magazines Gourmet, Saveur, Food and Wine, Kitchen Gardener, Fine Cooking, Orion, Organic Gardening and Eating Well, and for the Time-Life Cookbook Series. She has also written for Martha Stewart Living, Bon Appetite, Diversions, Kiplingers, Garden Design, Kitchen Garden, Cooks, Vegetarian Times, Metropolitan Home, East-West Journal, the Los Angeles Times, Home and Garden, and the International Slow Food Journal. When she first moved to New Mexico, Madison managed the Santa Fe Farmers' Market and served on its board for a number of year. Madison has been active in the Slow Food movement, founded the Santa Fe Chapter, was active on the ARK committee and served on the scientific committee of the Slow Food Foundation for Biodiversity. She is on the board of the Seed Savers Exchange and the Southwest Grassfed Livestock Association, and is the co-director of the Edible Kitchen garden at Monte del Sol Charter School in Santa Fe, New Mexico. She is the founding chef at Café Escalara in Santa Fe.  

It wasn't that long ago that there was a nutrition free-for-all in schools where sugary beverages, high calorie snack foods, and even things like pizzas and cheeseburgers direct from fast food chains were part of the food landscape in schools. What do you think the situation is today? Has it deteriorated even further? Has it improved or stayed about the same? Today's guest, Dr. Marlene Schwartz, is a champion for improved nutrition and physical activity in schools and one of the leading experts in the field. Schwartz is director of the Rudd Center for Food Policy and Obesity and professor of human development and family studies at the University of Connecticut. She's an expert on nutrition and physical activity policies in schools and preschools nationwide, and has collaborated in particular with the Connecticut Department of Education on their policies.   Interview Summary   Let me ask you about the food landscape in schools. When people generally think of this, they think of school breakfast, school lunch, but there's actually a lot more of the picture of food in schools than just this. And you've talked about this a lot. Can you help explain?   Sure. So the school meals are definitely the most visible aspect of school food. And when I first got into this work, I thought that was pretty much all there was. But once you go into the school, what you realize is that food is available from a lot of different sources. In the cafeteria, there is often food sold outside of the meal program that's called competitive foods. So those are snacks or other beverages. High schools often have schools stores where they can sell a whole variety of snacks and beverages. Schools also have vending machines that sell food. And then there are fundraisers that are often done during the school day where children can buy food. And then in addition to all the food that's sold, there's food that's simply given out in schools quite commonly, particularly at the elementary school level. There is a lot of food available during parties, birthday parties, holiday parties, as well as teachers who use food as a reward in the classroom. So once you go in and try to start changing school food, you realize that there are many, many different places that you have to try to influence.   So when you mention birthday parties and things, every child just has one once a year, and you wouldn't think it really adds up to a lot, but you've made a different argument. Tell us about that.   Well, I think that yes, parents think, "Well, my child only has one birthday a year." But of course your child is one out of 25 children in the classroom. And so my argument was really that you have to look at what's happening in the classroom overall over the course of a year. And I actually made a slide that showed all of the different holidays, all of the birthday parties that take place during the year, so that people could really see that when you started to count, there were parties happening pretty much every single week in elementary schools.   So returning to school meals, and the competitive foods, and things served a la carte and things in bending machines, how the heck did things get to be this way? I mean, were there federal, state, or local policies that permitted or even encouraged this? Were people making money? What made this happen?   It's really interesting to look into the history of competitive foods in schools. What I learned is that there are actually multiple layers of policies. And historically, the main policy was the federal policy, because the school meal programs are federal programs. But in the 1980s, the National Soft Drink Association, which is now known as the American Beverage Association, actually sued the federal government to make the case that they should not be allowed to regulate what was sold in schools outside of the school meals. And that was really the beginning of a very sort of troubled era, I would say, in the school food environment, because a lot of vending machines started going into the schools at that point, selling soft drinks. Companies even had something called pouring right contracts, which were essentially contracts with a particular brand, so Coke or Pepsi, where they would give the school money, they would provide the vending machines, and they would sell their products, and they would let the school have a cut of the profits. On the one hand, it helped the soft drink companies sell their product. They made some money from that. But I think what was probably more important to them is they got their brand in front of the students in that school. And the deal was you couldn't sell other brands of beverages.   I remember when we first started doing this work, I went to a high school in Connecticut, and I remember counting 13 vending machines as I was walking through the halls. So that was 13 times during the day, you know, children would be passing by that huge machine with the logo for that beverage company. There were really limited regulations during that era of what could be sold outside of the school meals. There was something called foods of minimal nutritional value, which was a pretty short list of things you couldn't sell. So it was things like cotton candy and lollipops. And there were also rules about not selling unhealthy foods for 30 minutes before the lunch period or 30 minutes after the lunch period. So you had a situation where sometimes there would be a vending machine in the hallway and they would unplug it for 30 minutes before lunch and then 30 minutes after lunch. But people could go plug in the machine, buy their soda, and then unplug it again. Those are the sorts of stories that you would hear.   So the good news is that things started changing in the early 2000s. People started to realize that it had gotten out of control, and States started passing regulations to get rid of some of these unhealthy competitive foods. And at the time, there really wasn't much promise of making a change at the federal level. So you had dates that were progressive passing laws that you couldn't sell soda or you couldn't sell certain unhealthy snacks in the schools. And then something interesting happened in 2006, which was the federal regulation was updated, basically saying that school districts needed to set their own policies. So it was somewhat of a political compromise. I think that the advocates had hoped that time that the federal regulation would actually say what the nutrition standards would be for competitive foods. But instead of that, they at least got this idea that, okay, you need to set your own policy. You can't just ignore this problem. And so it sort of forced the hand of school districts to at least put down on paper what their rules were for the snacks that they were selling outside of school meals. And so there was this period of time where schools really were responding to three levels of regulation, often. The federal regulation, if they lived in a state that had state regulations, they had those. And then also their own district regulation. It was quite confusing. And I think schools sort of struggled to figure out what they were doing and which regulations they were following. But things have definitely improved.   There are lots of interesting examples of individual parents making a difference in this problem by what they've done within their own school systems. So you don't necessarily just have to think about top-down things, and you're one such person. I remember that as a parent, when you had children in the Connecticut schools, that you made a big difference in the way the school system looked at things. So I'd love to hear just a little bit about how you approached that. What was the situation when you began working on it? And then what happened?   I was one of those parents and have a reputation that continues to follow me to this day. I had, you know, young children in the schools and was not happy with what was being sold in the schools. I wasn't happy with the number of times, as I mentioned, there were parties or teachers were handing out candy or coupons for donuts in the classroom. And so I got involved in my own elementary school with the principal, and we formed what was sort of ahead of its time, but it was essentially a school wellness committee. And we invited the school nurse, the PE teacher, some other parents joined. And we really tried to think about what could we do in our own school to make changes. And given that, you know, my training as a researcher taught me that you want to collect data, you want to keep track of what changes are occurring.   We began with a survey of parents in my school district that the district helped orchestrate. And I was able to document that parents overall really didn't want these unhealthy foods in schools. They didn't really like the snacks being sold in the elementary schools. They didn't like teachers handing out candy. And so I was able to then go back to the board of education with the data and convince them that we should have a stronger policy in our district. Now I will say that it turned out there was mixed feelings about it. Even though the majority of parents felt that way, there certainly were parents that didn't feel that way. And I got a lot of really great research ideas from going to different PTO meetings presenting the research on this topic and really hearing the way parents talk about it.   One of the things I learned pretty early on is that it really seemed like it wasn't so much about cupcakes in the classroom, but the arguments were more about what is the role of government? What is the role of policy? And when do you sort of let parents do whatever they want and when does the school or the school district have the right to say, "No, this is how we want things done in our district."   Well, what you've just said is a great example of how much difference a single parent can make. So let's talk about the federal government and what it's been doing. So a lot happened during the Obama administration on school food nutrition standards, and the Trump administration as well. But there's quite a contrast in the way these two administrations have been addressing this issue. Can you paint us a picture of this?   The Obama administration: I think of it now as the golden age of improvements in school food. You had a situation where States were passing policies. The federal government didn't do too much other than require these local policies. But because of all of that, it became evident that change really could happen. So you had whole States that got rid of all of the sugary drinks in schools like Connecticut. In 2006, K through 12, no sugary drinks could be sold in any of our schools. And essentially we proved as a state that this change could happen, that there wasn't a disaster. People didn't lose so much money, you know, that it was a huge problem. And so all of the arguments that have been made as to why you couldn't make these changes were kind of shown to be false because we were able to demonstrate that it could be done. I think those stories started accumulating. And then of course, Michelle Obama was a tremendous champion for children's health, for nutrition. And a piece of legislation called the Healthy Hunger-Free Kids Act of 2010 went through and I think completely transformed the school food environment. So that acted lots of things that really hadn't been done before. First of all, it revamped the nutrition standards so that they were in line with the dietary guidelines. So we saw things like increases in whole grains, increases in low-fat dairy, also more fruits and vegetables. And in addition to more in terms of larger quantities, also more variety in fruits and vegetables. So those changes were all really important. The other thing they did that was very new is they started setting calorie maximums for school meals instead of just calorie minimums. Those minimums had always been there because the concern was that kids weren't getting enough to eat. Now we had knowledge that we also needed to be careful about kids eating too many calories at school.   And then the other really major change that came with the Healthy Hunger-Free Kids Act is that lawsuit I mentioned from the National Soft Drink Association in the 1980s that prevented the federal government from regulating foods outside of the school meal programs finally was changed. And now the federal government started to set standards for the first time for all foods sold on school campus during the school day. And they developed something called Smart Snacks, which is a set of nutrition standards that went into effect that essentially regulates everything that's sold. So those were all wonderful changes.   I think the USDA did a great job developing the regulations, implementing them over time. It wasn't like everything happened overnight. There were several years where each year different levels of the changes would get implemented. Another important one was sodium levels. There had been very clear research documenting too much sodium consumption and that school meals had too much sodium. So there was a progressive series of three levels of sodium reduction that were scheduled. So then came the Trump administration. And I think there were a lot of concerns about whether things would go backwards because one of the priorities, it seemed, from the Trump administration was deregulation and taking away things like federal regulations. And in the end, some changes have taken place. So there've been a couple of rollbacks. One is the original Healthy Hunger-Free Kids Act regulation for milk said that all milk had to be 1% or fat-free, and there could be flavored milk, but it had to be fat-free flavored milk. And the reason was because that was a way to keep the calories below a certain level. So one of the roll backs was saying, no, you can have 1% flavored milk. So that was a change. Another had to do with whole grains. The regulation that had been implemented over time was that items needed to be what they call whole grain rich. And whole grain rich means more than 50% of the grains in the product are whole grains. And originally 50% of your grains had to be whole grain rich. And then it went up to 100% had to be whole grain rich. And essentially Sonny Perdue, about a year ago, rolled that back so that only 50% needed to be whole grain rich. So that was a step backwards. But I would say probably the biggest problem were the sodium changes. So as I said, there was this progression that had been scheduled pretty slowly to allow the industry time to reformulate to decrease the amount of sodium in schools. And essentially, Sonny Perdue announced last year that they were going to get rid of that third, most progressive level, and they were going to give more time to reach the second level. So it rolled back and then essentially stopped the progression in terms of improving the amount of sodium in schools.   So where do you think the most important advances in policy will be?   You know, I think that it goes up and down, if that makes sense. I think that things begin at the local level, because you have districts that really get out in front and have community that, you know, sort of taking this on as a priority. And then I think when you have districts showing that something can be done, it's more likely to happen at the state level. And then when things are done at the state level, oftentimes when you have a handful of states around the country that have demonstrated that something could be done, it's much easier for the federal government to make the changes. So if you're in a progressive state, the changes come earlier, because they are at those local and state levels. If you're in a less progressive state that doesn't tend to be out front on these issues, you really have to wait for the federal government to step in. That's what we've seen. And I wouldn't be surprised if it continued with that pattern.   So what do you think are the top priorities for what can be done in schools as we look forward?   The nutrition standards where they are, those rollbacks notwithstanding, I think are great. And I think it would be fine to keep them where they are now. I don't necessarily think that there need to be big changes there. What I think is more important now is to work on the culinary skill of people who are preparing school meals and find ways to help everyone make meals that follow those standards, but are also highly palatable and really attractive to the students. Overall, there have been a lot of success stories in terms of students liking the new school meals. I mean, we collected data in New Haven and documented very clearly that there had been no increase in plate waste, that children were eating the meals, they were eating more fruit than they were eating before. And I think that's the story in a lot of the cities and particularly districts that have 100% free lunch, so universal free meals. Those are the students who are used to eating school meals. They've been eating school meals since they came into schools. It's free, it's available for everyone, and that I think is often where you're going to see the most success. I think what's harder are the school districts that have a smaller proportion of students who qualify for free meals and therefore their rates of participation tend to be lower. They're faced with more challenges because they don't have the volume of participation that financially helps them invest in, let's say, new equipment or staff or training. And so they're the ones that I think have been struggling. And so I would love to see efforts to really help those districts learn from the districts that have seen a lot of success and kind of get the training, get the equipment, to really be able to provide meals that all of the students are going to want to eat.     Bio Dr. Marlene Schwartz is Director for the Rudd Center for Food Policy & Obesity and Professor of Human Development and Family Sciences. Dr. Schwartz's research and community service address how home environments, school landscapes, neighborhoods, and the media shape the eating attitudes and behaviors of children. Schwartz earned her PhD in Psychology from Yale University in 1996. Prior to joining the Rudd Center, she served as Co-Director of the Yale Center for Eating and Weight Disorders from 1996 to 2006. She has collaborated with the Connecticut State Department of Education to evaluate nutrition and physical activity policies in schools and preschools throughout the state. She co-chaired the Connecticut Obesity Task Force and has provided expert testimony on obesity-related state policies. She also serves on the Board of Directors of the Connecticut Food Bank.  

Food banks and food pantries provide life-saving help for families all around the country. Like other institutions addressing food issues, there is growing focus on providing not just food, but healthy food. There are complex issues in this picture, however, issues we can address with today's guest, Dr. Marlene Schwartz. Schwartz is director of the Rudd Center for Food Policy and Obesity and Professor of Human Development and Family Studies at the University of Connecticut.   Interview Summary   Many of our listeners will know in general how food banks work, but may not know the details. Can you explain in general how these organizations operate? Where do they get their food and where does it go?   There are two terms that you hear a lot: food bank and food pantry. So a food bank is basically a huge warehouse that will get food either directly from a factory, from the food industry, or from a large retailer, sometimes directly from farmers and then sometimes from food drives or other efforts to collect food to donate. Most food banks have an online ordering system for food pantries, so food pantries are much smaller. They are sometimes run by churches or other community centers, and they're typically fairly small places where the staff will obtain the food from the food bank and maybe some also in addition from other local retailers or donations, and then that's where the clients come in. And so the clients will go to the food pantry in their community and that's where they will obtain the food that they can then take home and use.   If there are other programs that help people with food-related needs like SNAP and WIC, how do food banks fit into this overall picture?   So, it's really interesting because when you look at the actual amount of food provided by certainly a program as large as SNAP or WIC, food banks are tiny by comparison. So it's really a very, very small percentage of food that individuals get from the charitable food system compared to SNAP and WIC. However, I think their role really goes beyond the food they provide. Oftentimes food pantries are a place where people can come and get access to other resources in their community. So as I mentioned, they're often in community centers or faith-based organizations that will not only provide the food, but sometimes provide assistance signing up for SNAP or WIC or finding out about other types of social services or resources that are in the community. And so I think that their role can really be measured not just by the amount of food that they distribute, but also the way in which they connect their clients with other resources and really provide a place of support for their community.   You've paid a lot of attention to using the healthiness of the food distributed as an index of success. So how's this different than what's been done traditionally?   Traditionally, the success of food banks or food pantries has been measured in the pounds of food. And it's really interesting because you can see why that was an attractive measure because it's super easy. You basically just put the food on a scale, you measure how many pounds it is, it's a number, you know when it's more or less, and it's pretty straightforward. But as often happens when things get measured is that sometimes the system evolves to really maximize the measure without thinking about the consequences. So really heavy products, like two liter bottles of soda, for example, became very popular to donate to food banks and food pantries because they weighed a lot. And other things like maybe a container of spinach or kale was not very popular to donate because you wouldn't necessarily see a big change in the number of pounds. So I think that we definitely need to start looking at it differently and looking at the volume of food and consider the nutritional quality of food and not just the pounds.   So what sort of things were getting donated that wouldn't be considered good nutrition?   Packaged foods are very popular to donate to food banks. A lot of the packaged snack foods, a lot of canned meals. So things like beef stew or, you know, Beefaroni, or other foods that are shelf stable and heavy and people sort of felt would be filling, those tended to be the foods that people automatically thought would be the best things to donate to food banks.   If people are really hungry and in need, doesn't it make sense just to give them anything that's available? And could you make that argument?   I am sympathetic to the argument that people are hungry and you need to just give them something, and then it's all about the volume and the amount and that's the most important thing. But in really doing research on the people who come to food banks, I learned a couple of really important things. First of all, their rates of diet-related diseases are much, much higher than the general population. So we've seen very high rates of type 2 diabetes, hypertension, and obesity. So you have to really think about the folks that are coming. They're at an even higher risk of those diseases. And the second thing is we started doing research where we actually asked clients, "What would you like to have at the pantry?" And the answers might surprise some people. We found that what was most important to them were fruits, vegetables, grains, dairy, meat. So they weren't really looking for these canned products or these packaged products. And they certainly weren't looking for things like salty snacks and sugary drinks. So when you really listen to people, you find out they want healthy groceries, just like everybody else. And so, in my opinion, if you are taking on the responsibility of running a food pantry or a food bank and providing food, you really need to think about the needs of the people you're serving.   Are food banks generally around the country thinking more about the nutrition quality of the foods they receive and how is this playing out?   I've been in this area of research probably for six or seven years now. And even in that short time, I've seen a big change. So when we first started doing work in this area, we did a national survey of people in food banks and we did interviews to try to hear about how they were thinking about nutrition. And I would say there were still a lot that took the position you mentioned earlier that it's about pounds and it's about getting the maximum amount of food out and nutritional quality is really secondary. But I think as the public conversation has changed and people have become more and more aware of the importance of healthy food and the concern of diet-related diseases, food banks have changed as well. And we did another survey last year and really found that a large number of food banks are thinking about these things. They're using nutrition ranking systems, they're developing nutrition policies. And Feeding America is a national organization overseeing a network of about 200 food banks. They've come a long way in terms of thinking about the role of nutrition and how they can really lead that way.   You've done some research yourself on food banks and nutrition programs. What sort of nutrition work can be done in the context of food banks? And is there information available on how well these approaches work?   I would say the first step that a lot of food banks have taken is what we're calling nutrition ranking. So it's essentially having a systematic way of scoring the food products that come in. Sometimes they use a stoplight system, sort of a green, yellow, red in terms of the nutritional quality. Sometimes it's a binary system where they sort of consider it like foods to encourage or not. But sort of whatever system you use, I think having a system where you're keeping track of the quality of food in a systematic way helps you in a number of ways. One, you can see your changes over time. Two, you can sort of see which donors are giving you the sorts of foods that you're looking for and which donors are not, and that can sometimes facilitate conversations with those donors. But we did a really exciting study recently, we just finished analyzing the data, where we then had the food that the food bank had collected. So this is a food bank here in Connecticut called Foodshare, and they implement a system called the SWAP system, which stands for Supporting Wellness at Pantries. And it's a green, yellow, red stoplight ranking system based on saturated fat, sodium, and sugar. And what they did is they rank all the food as it comes in, and then when they put it on their online shopping platform for the food pantries, and there are about 150 food pantries that shop at Foodshare for the food that they distribute, we actually showed them green, yellow, red next to the items so they could see the nutrition quality assessment like that. And because we knew we were going to do it, we were able to look before that information was available and after that information was available over about a three-year period of time with it changing in the middle. And what we found was that there was a significant increase in the proportion of the order that was green and a decrease in the proportion of the order that was red. So what this really suggests is that if you communicate that information, you can sort of shift the behavior of the people who are making the decisions. We did another study, then. We basically did the same thing at the pantry level. So we went into a food pantry and we reorganized their shelves so they were clearly labeled with sort of circles that were the color green, yellow, red, but then had words like "Low sugar, good for managing diabetes," or, "Low sodium, good for managing blood pressure." We did that before and after we had collected data with these clients, and again found the exact same thing, that when clients were given the information, they change their behavior and there was an increase in the proportion of what they took that was green and a decrease in the proportion of what they took that was red. So I think there's a lot of promise in this idea of simply measuring and providing that information, I think will nudge people in the right direction.   Those interventions that you designed are very creative and it's really nice that they were so powerful. And boy, that does really speak to what can be done in these settings. So you mentioned Feeding America, a national organization, then you said that they work with 200 food banks around the country. And also I know they work with 60,000 food pantries. So what role do they play in all this?   Feeding America is incredibly important because they are kind of this umbrella organization for food banks nationally. There are some food banks that aren't affiliated with Feeding America, but the vast majority of the food banks in the United States are. One of the things they're able to do is navigate donations from very, very large national donors. So they can keep track, for example, of, you know, if there's a huge shipment of, I don't know, butternut squash, they can sort of figure out where it is and communicate with different food banks and try to get the food where it needs to go by having sort of the big picture of the whole country in front of them. And so they're able to really help a lot with fresh vegetables and fresh fruit and making sure that things get where they can be distributed in a timely fashion. They also can provide a lot of education for the networks and they have a lot of information online to really help food banks and food pantries know the latest science and also have access to different resources. And they also have a lot of national conferences for different segments of the system, where they'll present the latest information and help different members of this system do as good of a job as they can.   If I ask you to peer into the future, what do you think food banks will look like going down the road?   Well, the future in my imagination is that food banks and food pantries will continue to provide nutritious foods and will really focus primarily on providing the most nutritious foods, but will also become places that really serve the communities that they're in. So what I think is the untapped potential of this system is having a place where folks who might not have other resources, let's say because maybe they're not working or they're not in school, to have a place in their community where they can go and get access to trainings and other resources and sort of help them get back on their feet so that they can be successful. And there's a colleague of mine named Katie Martin who has this concept called More Than Food, which is really this idea that food pantries can help people obtain other services, connect them with health care, connect them with educational opportunities. And in that way, I think can really get more at the root causes of the food insecurity in the first place. Bio Dr. Marlene Schwartz is Director for the Rudd Center for Food Policy & Obesity and Professor of Human Development and Family Sciences. Dr. Schwartz's research and community service address how home environments, school landscapes, neighborhoods, and the media shape the eating attitudes and behaviors of children. Schwartz earned her PhD in Psychology from Yale University in 1996. Prior to joining the Rudd Center, she served as Co-Director of the Yale Center for Eating and Weight Disorders from 1996 to 2006. She has collaborated with the Connecticut State Department of Education to evaluate nutrition and physical activity policies in schools and preschools throughout the state. She co-chaired the Connecticut Obesity Task Force and has provided expert testimony on obesity-related state policies. She also serves on the Board of Directors of the Connecticut Food Bank.