Americans are suffering...
Americans are suffering through an epidemic of chronic disease, led by cardiovascular disease, obesity, diabetes, poor mental health, digestive disorders, autoimmune diseases, and cancer. Public health officials advise lifestyle changes and doctors prescribe drugs that address symptoms, but rarely causes. This is an update introduction proposing a national high school debate topic on reforming federal food programs and dietary guidelines.
The Centers for Disease Control reports “90% of the nation’s $3.8 trillion in annual health care expenditures are for people with chronic and mental health conditions.”1 2 and a 2022 study concludes: “U.S. cardiometabolic health has been poor and worsening, with only 6.8% of adults having optimal cardiometabolic health, and disparities by age, sex, education, and race/ethnicity.” 3
Yet few Americans know what “metabolic health” means. The problem is compounded by wide disagreements among doctors and nutritionists on what to advise patients with high blood pressure, elevated cholesterol, obesity, pre-diabetes or type 2 diabetes. Critics say the U.S. health care system is biased toward prescribing drugs and medical procedures for symptoms instead of diet and lifestyle changes to address root causes (usually metabolic syndrome/insulin resistance)4.
Debaters [if this topic is chosen] will have an opportunity to survey the divergent opinions and research on America’s escalating chronic health problems. Health and nutrition challenges are especially stark for minorities and low-income families. Poor neighborhoods have plenty of fast food outlets and convenience stores but few grocery stores. This is partly a consequence of federal government SBA loan guarantees available for fast food franchises but not grocery stores. See the University of Chicago Press book: Supersizing Urban America: How Inner Cities Got Fast Food with Government Help
The Federal Dietary Guidelines for Americans contribute to the problem by limiting federal food programs to arguably nutritionally inadequate meals. These restrictions impact food served in public schools, hospitals, nursing homes, military bases, and prisons (one in four meals impacted)5. The Federal Dietary Guidelines continue to promote low-fat foods (including banning full-fat dairy), and restrict saturated fat as unhealthy. Quality nutrition research does not support the Federal Dietary Guidelines, especially for those (the majority) who are metabolically unhealthy. Promoting low-fat foods translates to promoting diets higher in carbohydrates. All sides oppose excess sugar but to compensate for the lack of taste of low-fat foods, sugar is often added (chocolate low-fat milk in schools, for example).
Among the challenges for debating this topic is the wide scope of chronic health conditions linked to poor metabolic heath. With poor nutrition the source of most chronic disease, this is as much a health care reform topic as a federal nutrition, meals programs, and dietary guidelines reform topic.
Earlier drafts of this paper focused mostly to obesity and type 2 diabetes since there is much published research to document the success of dietary changes (away from the Standard American Diet (SAD), and toward Mediterranean and low-carb diets). But even here there is wide disagreement over the cause of surging obesity and type 2 diabetes in Americans of all ages.
Current public health guidelines tend to “blame the victim”: they advise overweight people to just “eat less and exercise more” as if chronic health problems are caused by being overweight rather than excess weight gain as a consequence of poor metabolic health. People with metabolic syndrome/insulin resistance are “carbohydrate intolerant,” they have trouble metabolizing excess carbohydrates in the Standard American Diet (SAD), which in turn is a consequence of decades of public health officials promoting the low-fat Food Pyramid and Food Plate.
The debate here is between the “energy balance theory of obesity” and the “carbohydrate insulin model,” discussed below.6
Students will find a wide range of research and claims for the poor health of Americans:
• Some blame the obesity epidemic on larger portion sizes at restaurants where Americans eat out more often.
• And blame overly-processed, shelf-stable, packaged foods with sugar and seed-oil calories, but little nutrition. Food is stable, long-lasting, enriched, less expensive, but still far less nutritious.
• Food companies are blamed for designing hyper-palatable snacks that are hard-to-resist and even addictive. Popular soft-drinks with high-fructose corn syrup are also blamed.
• A culture of snacking through the day (popularized by nutritionists) is a subject of debate, with critics calling for a return to traditional one, two, or three main meals each day and fasting overnight (until breakfast).
• Blame also falls on the overuse of antibiotics in childhood disrupting microbiome diversity and contributing to poor gut health and constant inflammation.
Most Americans are unhealthy. But medical, nutrition, and public health experts disagree on the causes and disagree even on what foods are healthy. Tamar Haspel argues in a June 2023 Washington Post piece: “Don’t Believe the Backlash: Saturated Fat Actually is Bad for You” and Nina Teicholz replies in a July 2, 2023 Unsettled Science post “Canceling the Science on Saturated Fats: WashPost columnist Tamar Haspel pretends decades of science don't exist,” noting:
On saturated fats, Haspel’s arguments are squarely mainstream. In fact, her arguments are an almost exact replica of the strategy taken by the American Heart Association (AHA), the U.S. Department of Agriculture (USDA), and the World Health Organization (WHO) in defending their continued caps on saturated fats against a large body of scientific evidence to the contrary.
And Teicholz quotes Frank Hu in an earlier post: “I was wondering if we should have a separate section on low-carb diets rather than burying it,” wrote Harvard nutrition professor Frank Hu about the official expert report for the 2015 U.S. Dietary Guidelines for Americans. Over the past decade, thousands of scientists, doctors and others have urged officials overseeing our nation’s nutrition policy to pay attention to studies on low-carbohydrate diets, yet even as the science has advanced rapidly, the federal agencies in charge of the guidelines seem ever-more intent on ignoring and yes, burying the science.
Bradley K. Hobbs and Nikolai G. Wenzel argue in the Journal of Food System Dynamics (2020) that special interests captured the regulatory process: Federal Nutritional Guidance and the Politics of Science: A Tale of Regulatory Capture.
But whatever the history, today’s reality is stark: “Only 1 in 8 Americans are achieving optimal metabolic health, which carries serious implications for public health” and “Between 1999 and 2000 and 2017 and 2018, U.S. cardiometabolic health has been poor and worsening, with only 6.8% of adults having optimal cardiometabolic health, and disparities by age, sex, education, and race/ethnicity. These novel findings inform the need for nationwide clinical and public health interventions to improve cardiometabolic health and health equity.”
The Center for Disease Control’s Overweight & Obesity page links to its “Childhood Overweight & Obesity”: “Obesity is complex. Many factors can contribute to excess weight gain including behavior, genetics and taking certain medications. But societal and community factors also matter: child care and school environments, neighborhood design, access to healthy, affordable foods and beverages, and access to safe and convenient places for physical activity affect our ability to make healthy choices.”7
The “healthy, affordable foods” link opens: ‘Healthy Food Environments: Improving Access to Healthier Food” noting: “Each year, chronic diseases account for 70% of all deaths in the United States. Poor diets lead to chronic illnesses such as heart disease, type 2 diabetes, and obesity.” And “Each year, chronic diseases account for 70% of all deaths in the United States. Poor diets lead to chronic illnesses such as heart disease, type 2 diabetes, and obesity.”
The debate over what foods are healthy
Again a challenge for debaters is that medical and nutrition communities strongly disagree on what foods are healthy. The Federal Dietary Guidelines recommend lean meat (or plant-based protein sources), low-fat dairy, and many servings of whole grains and vegetables. Critics argue these dietary recommendations are not based on sound research and in any case do not apply to the majority of Americans who are metabolically unhealthy. How are we to improve access to healthy foods if experts don’t agree on which foods are healthy?
The White House Conference on Hunger, Nutrition, and Health (March 24, 2023), reports on the September 2022 conference: Ending Hunger and Reducing Diet-Related Diseases and Disparities, from White House Conference on Hunger, Nutrition, and Health8:
Millions of Americans are affected by food insecurity and diet-related diseases — including heart disease, obesity, and type 2 diabetes — which are some of the leading causes of death and disability in the U.S. The toll of hunger and these diseases is not distributed equally, disproportionately impacting underserved communities…
Link to pdf of full 16-pages draft nutrition debate topic proposal.
National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP). At: https://www.cdc.gov/chronicdisease/about/costs/index.htm#ref1
Prevalence of Optimal Metabolic Health in American Adults: National Health and Nutrition Examination Survey 2009-2016 (Metab Syndr Relat Disord, 2019 Feb;17) https://pubmed.ncbi.nlm.nih.gov/30484738/
Trends and Disparities in Cardiometabolic Health Among U.S. Adults, 1999-2018 (J Am Coll Cardiol, 2022 Jul 12) https://pubmed.ncbi.nlm.nih.gov/35798448/
Metabolic Syndrome, Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/10783-metabolic-syndrome DietDoctor Metabolic Health https://www.dietdoctor.com/science/metabolic-health
By law, the Guidelines also must be followed by all federal nutrition programs, including food assistance programs, which touch one in four Americans every month (they are the single-biggest expense at the USDA). These include: National School Lunch Program (NSLP); Supplemental Nutrition Assistance Program (SNAP) (formerly “Food Stamps”);Special Nutritional Program for Women, Infants and Children (WIC); Feeding programs for the elderly. [Bold added.] Source: “US Dietary Guidelines for Americans—101” https:// www.nutritioncoalition.us/dietary-guidelines-for-americans-dga-introduction
How a ‘fatally, tragically flawed’ paradigm has derailed the science of obesity (STAT News, September 13, 2021
At: www.statnews.com/2021/09/13/how-a-fatally-tragically-flawed-paradigm-has-derailed-the-science-of-obesity/