Food Politics

by Marion Nestle
Dec 12 2023

Food iS Medicine (FIM): the latest food movement (of sorts)

I subscribe to Jerry Hagstrom’s Hagstrom Report because he gets to go to things in Washington, D.C. and elsewere that I can’t get to but wish I could.

He reported last week (December 7) on the Food As Medicine Summit, and wrote about it in the National Journal — “Food as medicine’ on the table”.  This notes, among other things, that the minimum fee for attending was $399.

So what is the food-as-medicine movement? Advocates believe changing Americans’ diets away from the fat, sodium, and added sugars that have led to high levels of obesity and instead toward fruits, vegetables, fiber, and lean protein can reduce the need for prescription drugs and hospitalizations. The advocates want Medicare, Medicaid, and private insurers to pay for diet interventions like produce prescriptions.

He also reported on the accompanying Trade Show.

Food as Medicine is still an emerging concept, but there was a small trade show on the sidelines of the Food as Medicine Policy Summit that showed the range of companies that believe the food and health care industries need their products.

I was particularly interested in the trade show because the monetization of Food Is Medicine is a big concern.

Also last week, JAMA published a critique of the concept: “A “Food Is Medicine” Approach to Disease PreventionLimitations and Alternatives,” arguing that “the medical and public health communities’ enthusiasm for food is medicine seems unjustified by its likely benefit.”

The authors argue (my paraphrasing):

  • Evidence in support of FIM’s ability to improve health is weak.
  • Existing studies do not differential FIM from the effects of standard care.
  • FIM requires enrollment in the health care system (overburdened, dysfunctional, difficult to access).
  • Patient adherence to interventions is low (unless they are provided intact and paid for).
  • Existing federal food and nutrition programs are already known to work; they deserve more support.
  • The main beneficiary is the food industry, which gets to shift responsibility to the health care system.
  • Food companies will also benefit from sales of FIM products [hence the Summit Trade Show].

Count me as an FIM skeptic.  It’s nice for people who can get it; it is not likely to scale up enough to address chronic disease in any significant way.

Hagstrom lists these resources:▪
USDA National Institute of Food and Agriculture — Gus Schumacher Nutrition Incentive Program
Grey Green Media — Events
Food is Medicine Coalition

Dec 11 2023

Conflicted interests: obesity drugs, alcohol, clinical trials


Here’s the headline: Maker of Wegovy, Ozempic showers money on U.S. obesity doctors

Drugmaker Novo Nordisk paid U.S. medical professionals at least $25.8 million over a decade in fees and expenses related to its weight-loss drugs, a Reuters analysis found. It concentrated that money on an elite group of obesity specialists who advocate giving its powerful and expensive drugs to tens of millions of Americans.

What’s extraordinary about this situation is the amounts.  Some doctors got millions.

This account follows one about similar efforts in the UK: Revealed: experts who praised new ‘skinny jab’ received payments from drug maker.

The drug giant behind weight loss injections newly approved for NHS use spent millions in just three years on an “orchestrated PR campaign” to boost its UK influence.  As part of its strategy, Novo Nordisk paid £21.7m to health organisations and professionals who in some cases went on to praise the treatment without always making clear their links to the firm, an Observer investigation has found.

Novo Nordisk knew what it was doing, and its efforts (presumably legal) are certainly paying off.


The headline: Scientists in Discredited Alcohol Study Will Not Advise U.S. on Drinking Guidelines: Two researchers with ties to beer and liquor companies had been named to a panel that will review the health evidence on alcohol consumption. But after a New York Times story was published, the panel’s organizers decided to drop them.

Five years ago, the National Institutes of Health abruptly pulled the plug on an ambitious study about the health effects of moderate drinking. The reason: The trial’s principal scientist and officials from the federal agency’s own alcohol division had solicited $60 million for the research from alcohol manufacturers, a conflict of interest and a violation of federal policy.

I wrote about that in a previous post.

I’m told by people in the know that I should not be too hard on the scientists.  NIH told them it would not fund the study and they should get the funding from industry.  If true, that is unfortunate.

For sure, NIH is not interested in nutrition research except for genetically based “Precision” nutrition aimed at individuals.  That leaves population studies out of the picture.  Unfortunate, indeed.


The study: Industry Involvement and Transparency in the Most Cited Clinical Trials, 2019-2022

Among 600 clinical trials with a median sample size of 415  participants:

  • 409 (68.2%) had industry funding
  • 303 (50.5%) were exclusively industry-funded
  • 354 (59.0%) had industry authors
  • 280 (46.6%) involved industry analysts
  • 125 (20.8%) were analyzed exclusively by industry analysts.

Among industry-funded trials:

  • 364 (89.0%) reached conclusions favoring the sponsor.

Industry involvement in research in general and in nutrition research in particular deserves close scrutiny and much skepticism.

Drug companies are required to do research and to find their own funding.  That is not true of nutrition.

Everyone should be lobbying for more independent funding for nutrition research.

Dec 8 2023

Weekend reading: The Upstairs Delicatessen

Dwight Garner.  The Upstairs Delicatessen: On Eating, Reading, Reading about Eating, & Eating While Reading.  Farrar Straus & Giroux, 2023. 244 pages.

This book was given to me by my editor at Farrar Straus & Giroux (which is publishing the new edition of What to Eat in 2025).

And what a fun read it is.

For one thing, the title describes exactly how this book is constructed.

Garner (who I don’t know but wish I did) reviews books for the New York Times (his most recent is a review of Fuchcia Dunlop’s history of Chinese food).

He, as it turns out, is one serious foodie.

In this memoir of sorts, he notes what everyone he reads—and he reads everything—has to say about food.  The name-dropping result takes getting used to.  Here is an example from the chapter on shopping for food.

I push past the onions and put two leeks into my cart.  I like to slice off the tops, when cooking with them, and set them on the windowsill, where the crazy tendrils wave like Struwwelpeter’s hair in the children’s book by Heinrich Hoffmann…I take some arugula.  In Jonathan Franzen’s novel The Corrections, a failed academic named Chip eats arugula that’s “so strong it made his eyes water, like a paragraph of Thoreau.”  Arugula wasn’t well-known in America before the eighties.  When farmers began to grow it in California, they didn’t know how much to charge.  Cree’s [Garner’s wife’s] father, Bruce explained that in Europe the cost was roughtly equal to a pack of cigarettes.  According to Joyce Goldstein, in her book Insie the California Food Revolution, farmers listened to him and initially pegged arugula prices to the cost of Bruce’s Lucky Strikes.

This is all a great introduction to who is writing what about food, and wonderfully gossipy about people I’ve read too (and occasionally have met).

But wait.  How come he’s not quoting me?

I went right to the Index’s pages and pages of names.

Bingo!  There I am on page 93.

By now we’ve all read our Eric Schlosser, our Alice Waters, our Marion Nestle, our Michael Pollan.  These are first-rate writers and thinkers, and God bless them, but they can’t help, at times, sounding sanctimonious.

I am deeply honored by—and adore —being grouped with Schlosser, Waters, and Pollan.

But, ouch.  Sanctimonious?  Moi?

Oh well.  I enjoyed reading the book.  A lot.

Dec 7 2023

No, Virginia, correlation does not necessarily signify causation

On Thursdays I like posting things I want everyone to enjoy.

This one, I stole from Tamar Haspel, who writes about food for the Washington Post.

I follow her on X (the site formerly known as Twitter), where she recently posted:

This could be my all-time favorite BMI correlation!

In China and post-Soviet states, BMI correlates with corruption. The fatter, the crookeder.

The correlation she cites is from an article in the Economist, Are Overweight Politicians Less Trustworthy?










I agree.  This is a fabulous example of how correlation does NOT mean causation—a basic tenet of epidemiology often forgotten.

But here’s my personal favorite example.  I laugh every time I see it.


No, the Dietary Guidelines did not cause the prevalence of obesity to rise.

This is correlation, NOT causation.

For causes, please consider food overproduction, pressures on food companies to sell food when there is so much of it, and the shareholder value movement, which demands not only profits, but  continual growth in profits.  All of these forced food companies to find new ways to get everyone to eat more food (by creating an “eat more” food environment.  I discuss all this in Food Politics and my other books).

Correlation is lots of fun but causation requires much deeper analyses.

Sorry about that.

Thanks Tamar.

Dec 6 2023

Yet another Salmonella outbreak from cantaloupe

I’m having a hard time with this one.

Once again, the FDA is warning all of us : “Do not eat, sell, or serve recalled cantaloupes or recalled products containing pre-cut cantaloupe.”

The warning lists the products implicated and all the ones that have been recalled.

The CDC says much the same:

CDC is concerned about this outbreak because the illnesses are severe and people in long-term care facilities and childcare centers have gotten sick. Do not eat pre-cut cantaloupes if you don’t know whether Malichita or Rudy brand cantaloupes were used.

As of November 30, the toll is:

Total Illnesses: 117
Hospitalizations: 61
Deaths: 2

But that’s only in the U.S.  Canada reports illnesses too: 63 sick, 17 hospitalized and 1 death.

This, mind you, is from eating cantaloupe.

It’s not that nobody knew cantaloupe poses special safety problems.  It’s grown on the ground and is hard to wash.  If it is grown anywhere near animal wastes, it has a high risk of getting Salmonella on its rind.  Cutting through the rind can move harmful bacteria on the rind into the interior.

Food safety lawyer Bill Marler, who tracks such things, reminds us of previous lawsuits over cantaloupe food poisonings.

He also has some useful things to say about Salmonella during a Cantaloupe Outbreak – Symptoms and Treatment

Cantaloupes, he points out, might still be in season, but Salmonella should not be.

He quotes Perdue (sic Purdue) Extension on how to make cantaloupe safer: scrub and wash in very hot water.

But Marler has been quoted as saying he does not eat cut fruit (implying you should not either).

What’s infuriating about all this is that Congress passed the Food Safety Modernization Act to give the FDA the power to require safety plans from producers of every food under its jurisdiction.  This means cantaloupe growers are supposed to take steps—and test—to make sure the fruit is not contaminated with pathogenic bacteria.

Clearly, the system isn’t working.

The FDA needs to find out why not.

The FDA is chronically and infamously underfunded for what it is supposed to do.

Congress needs to pay attention to this issue.

Nobody should get this sick from eating cut fruit.

And if you haven’t seen the film featuring Marler (I’m in it too, briefly), take a look at Poisoned on Netflix.  It talks about cantaloupe, among other things worth knowing.

Dec 5 2023

The COP-28 UN Climate Change Conference in Dubai—items

COP-28, the UN’s climate change conference is happening in Dubai, right now.

I’m trying to make sense of it.  For starters, the irony:

But food—the effects of agriculture on climate change (and vice versa) is on its agenda this year—a major big deal.

That’s why a coalition of farmers, communities, business, and philanthropy has issued a call to transform food systems.

Here’s my collection of food-related items.

I.  Food Tank’s Danielle Nierenberg is on the job: more than 30 Food Tank partnered events are scheduled.

Once again, four pavilions will be devoted to food systems: Food and Agriculture, led by our partners and friends at FAO, CGIAR, International Fund for Agricultural Development, and The Rockefeller Foundation; Food Systems, spearheaded by the European Union-backed program EIT Food and a variety of other groups including the Food and Land Use Coalition; Food4Climate, organized by a variety of partners—including youth voices—pushing for a more humane and sustainable food system; and the Sustainable Agriculture of the Americas Pavilion facilitated by IICA, bringing together the global north and south across the hemisphere.  You can read Food Tank’s coverage of the roadmap, which was announced last year, here.

IIFoodDive: Food system transformation on the menu at COP28

III.  Reuters: Countries urged to curb factory farming to meet climate goals

IV.  The lunch menu: The summit is featuries roughly two-thirds plant-based menu to highlight the link between greenhouse gas emissions and livestock.  But the meat industry is fighting  back.

V.  DeSmog: Big Meat Unveils Battle Plans for COP28

VI.  The Guardian: Plans to present meat as ‘sustainable nutrition’ at Cop28 revealed: Documents show industry intends to go ‘full force’ in arguing meat is beneficial to the environment at climate summit.

VII.  The Meat Institute

The Meat Institute and the Protein PACT for the People, Animals & Climate of Tomorrow will highlight animal agriculture’s commitments and progress toward global goals in multiple high-level engagements at the UN Climate Change Conference (COP28) in Dubai November 30-December 12. The Protein PACT has organized or assisted with inviting expert speakers for six panels across five COP28 pavilions, including:

  • December 5 panel in the Food Pavilion, co-organized by IICA and the International Livestock Research Institute (ILRI) on the topic of sustainable and healthy livestock production systems
  • December 6 panel in the IICA pavilion, organized by the ​​Canadian Alliance for Net-Zero Agri-food on the topic of achieving net zero in agrifood systems
  • December 8 panel in the IICA pavilion, organized by the Protein PACT on the topic of principles, practices, and proof for animal agriculture driving climate and food security solutions
  • December 9 panel in the IICA pavilion, co-organized by IICA and ILRI on the topic of innovation and investment in livestock systems for climate change adaptation and  mitigation

VIII.  International Dairy Federation & European Dairy Association side event: How Animal Source Food Nourishes The World In Times of Climate Change.

IX. Vox: There’s less meat at this year’s climate talks. But there’s plenty of bull.  Meat and dairy are driving the climate crisis. Why won’t world leaders at COP28 do anything about it?

X.  Food Navigator: on The Emirates Declaration.  Food is finally at the top table but measurable targets are missing.  Over 130 prime ministers and presidents have today signed the Emirates Declaration at COP28 – a first of its kind commitment to adapt and ‘transform’ food systems as part of action on the climate crisis…. Read more

Comment: The Emirates Declaration on Sustainable Agriculture, Resilient Food Systems and Climate Action is the firsr statement out of this meeting.  It doesn’t mention fossil fuels (the elephant in this particular room) or meat.  But it does propose:

1. Financial and technical support for sustainable solutions, capacity building, infrastructure, and innovations for farmers, fisherfolk, and other food producers.while conserving, protecting and restoring nature.

2. Promoting food security and nutrition.

3. Supporting workers in agriculture and food systems whose livelihoods are threatened by climate change.

4. Strengthening water management .

5. Conserving, protecting and restoring land and natural ecosystems, enhancing soil health, and biodiversity, and shifting from higher greenhouse
gas-emitting practices to more sustainable production and consumption approaches, including by reducing food loss and waste and promoting sustainable aquatic blue foods.

As for how and when?

To achieve these aims – according to our own national circumstances – we commit to expedite the integration of agriculture and food systems into our climate action and, simultaneously, to mainstream climate action across our policy agendas and actions related to agriculture and food

In the meantime, consider these:

What will it take to stop the impending disaster?  This has to be #1 on the advocacy agenda.

Dec 4 2023

Why I care about conflicts of interest

For years now I have been posting on Mondays something about conflicts of interest in nutrition research and practice on this site .

My goal in doing so is to raise awareness of practices that give the nutrition profession the appearance of undue food industry influence at the expense of public health.

Occasionally someone involved with something I post requests a correction or clarification.

Most recently, I heard from Gunter Kuhnle, a researcher in the UK whom I do not know personally.   He wrote:

In your blog (, you comment about my article in “The Conversation” on flavanols. This comment concludes with a statement that could be interpreted as if I was paid to write this piece. I would like to make clear that I was not paid to write this article – it was conceived and written in order to address a number of misunderstandings in the reporting of various studies concerning flavanols.  I would appreciate if you could correct this.

Since that was not at all my intention, I clarified the post immediately.

But I also requested his permission to reprint his note so I could do some more explaining about why this issue so concerns me.

I want to start by emphasizing that I do not see this as a personal matter.  My original post did not mention the author’s name and in general I try to avoid mentioning names of authors of industry-funded research unless they report financial ties to companies with vested interests in the outcome of that research.

I see this as a systemic issue.

But to summarize the arguments—and the research—I make and summarize in my book, Unsavory Truth: How Food Companies Skew the Science of What We Eat:

An enormous body of evidence, most of it derived from studies of tobacco, chemical, or pharmaceutical drug industry-sponsored research, consistently shows:

  • Industry-funded research generally yields results that favor the sponsor’s interests.
  • Industry funding of research influences its outcome.
  • The influence of industry funding usually shows up in the framing of the research question or in the interpretation of results.
  • Recipients of industry funding do not recognize the influence, do not intend to be influenced, and deny the influence (“science is science”).
  • Denial of influence contradicts an enormous body of evidence to the contrary.
  • Disclosure of funding source or relationships is necessary but not sufficient; considerable evidence exists to show that the statement “the sponsor had nothing to do with the design, conduct, or publication of the study” is often misleading or false.
  • Exceptions do exist, but they are rare.

That researchers do not recognize the risks of industry funding is disturbing.  At the very least, when nutrition researchers accept funding from food companies, they give the appearance of conflict of interest.

And that is all it takes to reduce public trust in nutrition research, nutrition professionals, and nutrition professional societies.

I think there is something seriously wrong when I can look at the title of a nutrition research article and make a good guess about what company or industry trade association funded it.

I think there is something seriously wrong when I can look at the funder of a study and guess what the outcome is.

One more point: an argument I hear often is that all nutrition researchers are biased because they have dietary or ideological preferences.  There is research on this point too.  It argues that all researchers have personal or ideological biases—that’s what motivates them to do studies to test their hypotheses.  Personal biases, therefore, are universal and do not cause conflicts of interest.

Industry funding introduces a quite different motive: proving the health benefits or safety of a food product for commercial—not scientific—purposes.

Unsavory Truth provides references for all of this.

Also see Science in the Private Interest:  Has the Lure of Profits Corrupted Biomedical Research? by the late Sheldon Krimsky (I miss him terribly).

Professor Kuhnle, I thank you for writing and for the opportunity to respond.

Dec 1 2023

Weekend reading: The Taste of Water

Christy Spackman.  The Taste of Water: Sensory Perception and the Making of an Industrial Beverage.  University of California Press, 2023. 289 pages.

Food Studies scholar Christy Spackman proves that, yes, an entire book—-and a riveting one at that—-can be devoted to how water tastes, thereby explaining how it can be turned into a bland commodity with its non-taste sold at exorbitant cost.

My blurb for it:

After reading this book, I now view tasting water as just the same as tasting food, and so will you.

Here is a brief excerpt:

The tasting work done by the Nestlé team, and subsequent website and print information, paints a specific form of relationship between environment and corporation. Rather than highlighting Nestlé Waters (and one might say, all bottled water producers) as operating via extractive economies that produce PET bottles that then circulate in the environment for millennia in increasingly small particles—the tasting situated Nestlé as a core protector of the environment. Teaching dégustation meant teaching consumers to prioritize terroir, rather than the entire political economy of bottled water production….the stories that emerge through dégustation prioritize attention to long-standing understandings of the relationship between earth, food, and flavor at the expense of more recent environmental impacts of water exploitation. Attending to terroir makes it is easy to miss that the systems and ways in which bottled water is produced are, like municipal water, deeply technoscientific.

Another one:

Frankly, from a flavor perspective, for many people accustomed to the taste of bottled water, or filtered tap water, the ingestible argument DPR presents is pretty exciting. DPR [Direct Potable Reuse—i.e., reclaimed] water directly from Scottsdale’s Tap 2 completely lacks the green, musty flavors that plague so many water producers in the metropolitan Phoenix region. It tastes remarkably—or eerily—similar to many mainstream bottled water brands with its lack of minerality. Current proposals for integrating DPR into municipal water sources anticipate blending the purified effluent with treated water from the regular source. Once regulatory bodies take the step of allowing DPR, in the near future water will still slightly taste of the rivers, lakes, canals, wells, and aquifers it travelled through. Just less so.

Full disclosure: Christy Spackman is a doctoral graduate of NYU’s Food Studies program and we could not be more proud of what she has accomplished.  Read her book, judge for yourself, and enjoy!