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The MAHA Commission released its report last week: The MAHA Report: Make Our Children Healthy Again.  Assessment.

This is one impressive report, forcefully written and tightly documented (it cites my work, among that of many others).

Overall, it paints a devastating portrait of how our society has failed our children.

It begins by stating that “The health of American children is in crisis” due to:

• Poor diet
• Aggregation of environmental chemicals
• Lack of physical activity and chronic stress
• Overmedicalization

The result: high rates of obesity, type 2 diabetes, neurodevelopmental disorders, cancer, allergies  and mental health problems among kids.

Here are some selected items I particularly appreciated in the report.  The bullet points are direct quotes.

On poor diet

• Most American children’s diets are dominated by ultra – processed foods (UPFs ) high in added sugars , chemical additives , and saturated fats, while lacking sufficient intakes of fruits and vegetables.
• Pesticides , microplastics , and dioxins are commonly found in the blood and urine of American children and pregnant women— some at alarming levels.
• Children are exposed to numerous chemicals , such as heavy metals , PFAS , pesticides , and phthalates, via their diet, textiles, indoor air pollutants, and consumer products.
• To get into schools , many food companies have reformulated their products with minor ingredient adjustments to qualify for the federal Smart Snack program by meeting the school nutrition standards, which children can purchase separate from school meals.

The driving factors for poor diets

• Consolidation of the food system
• Distorted nutrition research and marketing
• Compromised dietary guidelines

On the dietary guidelines  

They maintain problematic reductionist recommendations, such as:

• Advising people to “reduce saturated fat” or “limit sodium” instead of focusing on minimizing ultra-processed foods.
• Treating all calories similarly, rather than distinguishing between nutrient-dense foods and ultra-processed products.
• Remain largely agnostic to how foods are produced or processed: There is little distinction between industrially processed foods and home-cooked or whole foods if their nutrient profiles look similar.
• Added sugars, saturated fats and sodium are treated as proxies for ultra-processed foods. For instance, a cup of whole-grain ready to eat fortified breakfast cereal and a cup of oatmeal with fruit might both count as “whole grain servings,” and the guidelines do not weigh in on differences in processing.

They also,

• Do not explicitly address UPFs.
• Have a history of being unduly influenced by corporate interests .

On food systems

• The greatest step the United States can take to reverse childhood chronic disease is to put whole foods produced by American farmers and ranchers at the center of healthcare.
• Traditional Field Crops vs. Specialty Crops : Historically, federal crop insurance programs have primarily covered traditional field crops like wheat , corn , and soybeans, while providing much less support for specialty crops such as fruits, vegetables, tree nuts, and nursery plants.

On Corporate Capture 

• Although the U.S. health system has produced remarkable breakthroughs, we must face the troubling reality that the threats to American childhood have been exacerbated by perverse incentives that have captured the regulatory bodies and federal agencies tasked with overseeing them .
• Limited comparisons between industry-funded research versus non- industry studies have raised concerns over potential biases in industry-funded research…Additionally, some industry leaders have engaged in promoting ghostwriting and sponsored reviews to influence the scientific literature.
• Notably, this ghostwriting strategy mirrors tactics used by the tobacco industry to distort scientific consensus is largely propelled by “corporate capture,” in which industry interests dominate and distort scientific literature, legislative actions, academic institutions, regulatory agencies, medical journals, physician organizations, clinical guidelines, and the news media.
• The pharmaceutical industry, with its vast resources and influence, is a primary driver of this capture, though similar dynamics pervade the food and chemical industries.

Research recommendations

• GRAS Oversight Reform: Fund independent studies evaluating the health impact of self-affirmed GRAS food ingredients, prioritizing risks to children and informing transparent FDA rulemaking.
• Nutrition Trials: NIH should fund long-term trials comparing whole-food, reduced-carb, and low-UPF diets in children to assess effects on obesity and insulin resistance.
• Large-scale Lifestyle Interventions: Launch a coordinated national lifestyle-medicine initiative that embeds real-world randomized trials-covering integrated interventions in movement, diet, light exposure, and sleep timing-within existing cohorts and EHR networks.

Comment

The report has been criticized for not getting some of the science right.  The agriculture industry is particularly concerned about the attack on the chemicals it uses.  It is said to be outraged by the report.  The report did throw Big Ag this bone: “Today, American farmers feed the world, American companies lead the world, and American energy powers the world.”

But the report raises one Big Question:  What policies will this administration come up with to deal with these problems?  These, presumably, will be in the next report, due in about 80 days.

This is an extraordinary report, a breath of fresh air in many ways, and I would love to know who wrote it.

But to fix the problems it raises will require taking on not only Big Ag, but also Big Food, Big Pharma, Big Chemical, and other industries affected by these and its other recommendations (the report also says a lot about drugs and mental health).  Big Ag has already weighed in.  Others are sure to follow.

Oh.  And it’s hard to know how policies can be implemented, given the destructive cuts to FDA, CDC, and NIH personnel and budget.

I will be watching this one.  Stay tuned.

Resources

• The press release: MAHA Commission Unveils Landmark Report Exposing Root Causes of Childhood Chronic Disease Crisis
• The Executive Order establishing the MAHA Commission
• The Commission report: Make Our Children Healthy Again Assessment

Additional resource

• Errol Schweizer sent me his analysis on Medium, well worth reading.

If you are going to do advocacy (or be an activist, if you prefer), it’s likely to be far more effective if done right.  The steps begin with identifying the problem you want solved, deciding what you want to do to solve it, and figuring out who or what you have to convince to solve the problem.

Note: the best thing I’ve ever read about how to do this is the Midwest Academy’s how-to manual for activists, Organizing for Social Change.

Research is a crucial component of effective policy advocacy; it’s the basis of convincing change agents to agree to make the change.

The Global Health Advocacy Incubator (“Changing Policies to Change Lives”) and the Campaign for Tobacco-Free Kids have  just published Research for Advocacy Action Guide: Five Stretegies to Use Research in a Policy Change campaign.

This tells you what to look for, how to find it, what to highlight, and how to present it. Download the Guide.

The research piece extends the information in these groups’ Advocacy Action Guide, a shorter version of the information from the Midwest Academy.

Advocacy done “by the book” has a much better chance of success than what might seem intuitive.  These guides are well worth reading.

Advocacy, by the way, is one of the words on the government’s new forbidden list.  This alone is why we need it more than ever.  Get to work!

If you have any doubts about the value of the concept of ultra-processed, the breadth and extent of industry pushback against the idea is excellent evidence.  The concept is an existential threat to the processed food industry, and it is fighting back.  The Italian food industry is especially concerned because it also has the Nutri-Score front-of-pack labeling system to contend with; the letter grades on ultra-processed products tend to be C’s, D’s, and E’s—as bad as they come.

Here’s an example of the pushback.

The opinion piece: Visioli, F., Del Rio, D., Fogliano, V., Marangoni F, Ricci C, Poli A.  Ultra-processed foods and health: are we correctly interpreting the available evidence?. Eur J Clin Nutr 79, 177–180 (2025). https://doi.org/10.1038/s41430-024-01515-8

Competing interests: AP and FM are the Chairman and Scientific Director, respectively, of NFI—Nutrition Foundation of Italy, a non-profit organisation partially supported by Italian and non-Italian Food Companies. All other authors declare no conflict of interest associated with this publication.

Comment: The senior (last) author and one other run the Italian Nutrition Foundation, an organization sponsored by food companies, Italan and international.  This makes the Foundation an industry front group, pretending to be independent, but not.  Its job is to further the commercial interests of its corporate sponsors, which is what it is doing here.  It is using the tobacco industry playbook: cast doubt on the research, suggest alternatives, argue against regulation.  The foundation’s authors are joined by academic and government authors, who have their own, not necessarily commercial, reasons for unhappiness with the UPF concept, which focuses on degree of processing, not nutrient content.  Yes, nutrients matter, but there are better ways of getting them than through UPFs.

At the end of December, I received an email from Paula Johns, director of ACT Health Promotion in Brazil.

Today we are celebrating the approval of the tax reform in Brazil. This Tuesday, Dec 17th, the text was approved by the National Congress!!

The tax reform is a historic achievement for Brazil and we celebrate the fact that products harmful to health, such as tobacco, alcohol and sugary drinks, are included in the selective tax. We followed each stage of the discussion and saw the intense lobbying by the economic sector that profits from these products to weaken the selective tax proposal, but it was finally approved, as well as the tax-exempt basic food basket, with healthier products in accordance with the Brazilian Food Guidelines.

…Important to highlight that our National Congress is one of the worst we’ve ever had! To beat The Coca-Cola lobby there is quite an achievement! Wanted to celebrate with you. The inclusion of carbonated drinks in the selective tax now opens the door for a broader discussion about other categories of ultraprocessed foods in the revision that will happen in five years from now.

I also received a press announcement: “Historic Public Health Victory”: Vital Strategies Applauds Brazil’s Approval of Selective Tax on Tobacco, Soft Drinks, and Alcohol

The newly approved legislation includes annual tax adjustments for tobacco, soft drinks and alcohol in line with inflation. Additionally, it establishes an innovative basic food basket of healthy, sustainable products exempt from taxation. The tax reform also grants a 60% reduction in tax rates for horticultural and minimally processed products, nuts, oils, flours, and items from Brazil’s rich socio-biodiversity.  These measures will help ensure better access to nutritious food while discouraging consumption of unhealthy commodities.

…The specific tax rates for tobacco, alcohol, and soft drinks will be determined in 2025. To fully realize the public health benefits of this new tax structure, the levels of tax must be sufficient to reduce consumption. Vital Strategies, Brazil, will collaborate closely with partners to advocate for tax rates that prioritize public health. Setting these rates at levels that significantly reduce consumption of harmful products will protect communities from preventable diseases.

I tried to find more details, and hit upon Covington ‘s Brazil’s historic tax reform: a primer.  This lays out what will have to happen before implementation.  It says almost nothing about the public health taxes except this:

Key Change: the Selective Tax
In addition to the dual VAT (CBS/IBS), the reform establishes a new Selective Tax (IS) to regulate goods and services it characterizes as having significant negative health and environmental externalities. The IS will be charged on production, extraction, sale, or importation of these goods and services.

This will be interesting to watch.  Stay tuned!

The Dietary Guidelines Advisory Committee may not think there is much to ultra-processed foods (UPF), but companies making them have just been served with a lawuit.

I learned about this from a tweet (x) from Carlos Monteiro, the Brazilian public health professor who coined the UPF term.

CMonteiro_USP (@Carlos A. Monteiro) posted: A first-of-its-kind lawsuit against 11 UPF industries alleging they engineer their UPF products to be addictive with details on the actions taken to target children including internal memos, meetings & the research conducted to create addictive substances.

The lawsuit, filed by several law firms, is aimed at Big Food: Kraft, Mondelez, Post, Coca-Cola, PepsiCo, General Mills, Nestle, Kellanova, WK Kellogg, Mars, and Conagra.

The suit charges that these firms, through their deliberate marketing, are making people sick.

Due to Defendants’ conduct, Plaintiff regularly, frequently, and chronically ingested their UPF, which caused him to contract Type 2 Diabetes and Non-Alcoholic Fatty Liver Disease Plaintiff is now suffering from these devastating diseases, and will continue to suffer for the rest of his life.

The suit makes interesting reading.

Some examples:

• Big Tobacco companies intentionally designed UPF to hack the physiological structures of our brains.  These formulation strategies were quickly adopted throughout the UPF industry, with the goal of driving consumption, and defendants’ profits, at all costs.
• The same MRI machines used by scientific researchers to study potential cures for addiction are used by UPF companies to engineer their products to be ever more addictive.
• Big Tobacco repurposed marketing strategies designed to sell cigarettes to children and minorities, and aggressively marketed UPF to these groups.
• The UPF industry now spends about $2 billion each year marketing UPF to children.
• UPF increase the risks of disease because they are ultra-processed, not because of how many grams of certain nutrients they contain or how much weight gain they cause. Therefore, even attempts to eat healthfully are undermined by the ultra-processed nature of UPF. One cannot evade the risks caused by UPF simply by selecting UPF with lower calories, fat, salt, sugar, carbohydrates, or other nutrients.
• The UPF industry is well aware of the harms they are causing and has known it for decades. But they continue to inflict massive harm on society in a reckless pursuit of profits.

Can’t wait to see what happens with this one.  Stay tuned.

Resources

Consumer Federation of America: “Ultra-processed Foods: Why They Matter and What to Do About It.”

With government officials reluctant to issue advice on ultra-processed foods (UPFs), Consumer Federation of America aims to raise awareness about research on UPFs, explain the leading theories of how they harm health, and build support for public policies to reduce harms from UPFs in our diet.

The report pushes back on arguments that researchers have not consistently defined UPFs, or that the categorization lacks scientific rigor. In fact, researchers have operationalized the “Nova classification” system behind UPFs in a largely consistent manner, defining foods based on whether they contain ingredients that are “industrial formulations” or “rarely used in home kitchens,” with little serious disagreement about which ingredients should be considered “ultra processed.” Consumers can take CFA’s online quiz to test their knowledge of which ingredients are markers of “ultra processing.”

New research: Trends in Adults’ Intake of Un-processed/Minimally Processed, and Ultra-processed foods at Home and Away from Home in the United States from 2003–2018.  J Nutr 2024, https://doi.org/10.1016/j.tjnut.2024.10.048.  The data show that 50% or more of calories are consumed from UPF at home, away from home, and by pretty much everyone.

New research: Hagerman CJ, Hong AE, Jennings E, Butryn ML. A Pilot Study of a Novel Dietary Intervention Targeting Ultra-Processed Food Intake. Obes Sci Pract. 2024 Dec 8;10(6):e70029. doi: 10.1002/osp4.70029.  Behavioral interventions to reduce UPF intake cut calories by about 600 calories per day.

My post summarizing the three studies demonstrating that diets high in UPF induce intake of an excess of 500, 800, and 1000 calories per day.

This is a report from the WHO Regional Office for Europe: Commercial determinants of noncommunicable diseases in the WHO European Region.  

This report describes how i”7500 deaths per day in the Region are attributed to commercial determinants, such as tobacco, alcohol, processed food, fossil fuels and occupational practices. These commercial products and practices contribute to 25% of all deaths in the Region.

These industries, says WHO, “glamourize and normalize the use of harmful products, including harmful ones often targeting children and socioeconomically disadvantaged groups and others.”

Overall, it documents how these industries use their market power to:

• Maintain monopolistic positions, extend product lines into new sectors, and manipulate pricing
• Engage in political practices to prevent, weaken, and delay public health regulations
• Influence scientific research and public understanding of health issues to favour their commercial interests
• Use CSR [corporate social responsibility] initiatives to improve their public image and gain influence
• Avoid taxes, shift profits to tax havens
• Use financial strategies to deprive governments of revenues needed to fund public health.
• Use laws to oppose policies aimed at addressing the NCD burden
• exploit crises and emergencies to advance their commercial interests

In other words, this report describes how industries use the “playbook” to advance their interests.

While specific to Europe, its findings and recommendations are widely generalizable.

And the report gives plenty of references for everything it reports and recommends.

I received an e-mailed press release from the Senate Committee on Health, Education, Labor, and Pensions (HELP), chaired by Sen. Bernie Sanders (I-VT):  NEWS: Sanders and Booker Take on Food and Beverage Industry with New Legislation to Address Childhood Diabetes and Obesity Epidemics.

Sen. Sanders, along with Sens. Cory Booker (D-NJ) and Peter Welch (D-VT), have introduced legislation to

Take on the greed of the food and beverage industry and address the growing diabetes and obesity epidemics negatively impacting millions of American children and families across the country. The Childhood Diabetes Reduction Act establishes a first-of-its-kind federal ban on junk food advertising targeted to children in the United States, requires the Food and Drug Administration (FDA) to implement strong health and nutrient warning labeling, directs the National Institutes of Health (NIH) to investigate the dangers posed by ultra-processed foods, and develops a national education campaign for children and caregivers through the Centers for Disease Control and Prevention (CDC).

The press release quotes Sen. Sanders:

“Let’s be clear: The twin crises of type 2 diabetes and obesity in America are being fueled by the food and beverage industry that, for decades, has been making massive profits by enticing children to consume unhealthy products purposely designed to be overeaten…We cannot continue to allow large corporations in the food and beverage industry to put their profits over the health and well-being of our children.

Nearly 30 years ago, Congress had the courage to take on the tobacco industry, whose products killed more than 400,000 Americans every year. Now is the time for Congress to act with the same sense of urgency to combat these diabetes and obesity epidemics. That means banning junk food ads targeted to kids and putting strong warning labels on food and beverages with unacceptably high levels of sugar, salt, and saturated fat.”

Resources:

• Senate hearing:  What is Fueling the Diabetes Epidemic?
• Sanders’ letter  to the FDA to require warning labels on unhealthful food products
• The bill, section-by-section, is here.
• The bill text is here.

At long last, congressional representatives are trying to do something to prevent childhood obesity.  Let’s urge our representatives to sign on to this bill.

The UN’s World Health Organization (WHO) has long led efforts to tax unhealthy products, starting with tobacco.

WHO describes its health tax efforts here.

It recently issued Global report on the use of sugar-sweetened beverage taxes, 2023.

The report finds that 108 countries have some kind of tax on sugar-sweetened beverages.

But, it finds

Less than a quarter of countries surveyed account for sugar content when they impose taxes on these non-alcoholic beverage products. Countries with a sufficiently strong tax administrative capacity are encouraged to tax beverages based on sugar content, as it can encourage consumers to substitute with alternatives that have lower sugar content as well as incentivize the industry to reformulate beverages to contain less sugar.

One of its major overall findings:

Among its conclusions are these:

• Existing taxes on SSBs could be further leveraged to decrease affordability and thereby reduce consumption. While other perspectives and competing factors have to be accounted for when designing taxation policies, the protection of health should be a key consideration, particularly considering the health and economic burden associated with obesity and diet-related NCDs.
• This report concludes that excise taxes on SSBs are not currently being used to their fullest potential. Improving tax policy and increasing taxes so that SSBs become less affordable should be pursued more systematically by countries in order to effectively reduce consumption and prevent and control diet-related NCDs, including obesity and dental caries.

Here’s the evidence.  Get to work!

Resoures

• More about WHO’s work on health taxes
• Global report on the use of alcohol taxes, 2023
• WHO technical manual on alcohol tax policy and administration
• Health taxes database