It's no secret that the U.S. diet is woefully unhealthy. According to the University of Washington's U.S. Burden of Disease Collaborators, dietary factors are associated with about 530,000 of the 2.7 million annual U.S. deaths. The World Health Organization lists poor diet as a major contributor to deaths from chronic disease throughout the world (Reference 1). The culprits are easy to identify: too much refined sugar, too much salt, too little fruit and vegetable consumption, and too much red meat. Add too much alcohol consumption if you want to consider alcohol a food. Our current state of unhealthy, low quality cheap food – a product of federal government agricultural policy in the 1970's – is so entrenched that consumers must expend considerable effort to acquire nutritious food on their own and they must demand policy changes to enhance the public's health as a counter force to the food industry. Such changes are not rocket science, nor do they require gobs of nutrition research. Making the U.S. diet healthy is a matter of will.
Prominent nutrition researchers have proposed (References 2 and 3 below) the following policy changes to promote a healthier food supply that would improve diet quality, prevent disease, and enhance well-being.
1. Tax Sugar-Sweetened Beverages. Higher cost → lower consumption → less overweight, type 2 diabetes, and heart disease. Mexico, the UK and 23 other countries have done this. Mexico's 2014 tax produced a 9.7% reduction in soda consumption. It's too soon to determine if reduction in soda consumption will produce the expected benefits but there's every expectation that it will. In the meantime, worldwide sales of sugar-sweetened soda have declined anyway as consumers seek healthier beverage options such as bottled water. (The goal now is to get rid of individual plastic beverage containers).
2. Reduce Sodium (salt) in Processed Foods. Less salt → less high blood pressure → less heart disease and stroke. Several countries (e.g. Argentina and South Africa) have mandated reduction of salt in key foods. The UK and Canada have reached agreements with industry on voluntary reduction targets. The U.S. FDA is seeking public comment on plans for short-term (2 year) and long-term (10 year) voluntary sodium reduction in commercial and restaurant foods (https://www.fda.gov/food/ingredientspackaginglabeling/foodadditivesingredients/ucm253316.htm)
3. Require Effective Front-of-Package Nutrition Labels. Success with eliminating trans-fats from the American food supply shows that nutrition labeling can work. The problem is you need a PhD in nutrition to understand the Nutrition Facts label and the health consequences of what it communicates. Chile has adopted front-of-package labels with graphical stop signs to highlight excessive calories, salt, and sugar. Canada and other countries are considering similar moves. Unfortunately, the U.S. federal government cannot find graphic designers to carry out a similar approach for U.S. consumers.
4. Eliminate Marketing of Unhealthy Food to Children. Mass media advertising for food products generally promotes unhealthy eating for everyone including children. Virtually all food advertising at children promotes processed and restaurant foods with higher-than-recommended levels of calories, sodium, added sugars, and saturated fat. Sweden and Quebec have banned all advertising directed at children. The U.S. Congress is unlikely to do that until 100% of all children in public schools under age 14 are obese and prediabetic.
5. Increase Subsidies to Low-Income People for the Purchase of Healthy Foods. Because of cost and limited access, fruit and vegetable consumption among low-income individuals is considerably less than recommended. It's known that lowering barriers to low-income individuals acquiring fresh fruits and vegetables increases consumption by 30%. Time for researchers to show that high quality food subsidies costs the country less than public medical care costs for diabetes of low-income people.
6. Improve Restaurant Meals. Americans gets one-third of their calories from meals purchased outside the home. Regulating the content of those meals to achieve a minimal level of healthfulness seems unlikely. But mandating informing consumers of the relative healthfulness of their restaurant choices with regard to calories, salt, and sugar, as some communities do, might help. More Ph.D. theses on this are needed.
7. Mount Campaigns to Promote Healthier Diets. That countering industry advertising with sustained mass media health messages reduced cigarette smoking and consumption of sugar-sweetened beverages suggests that banning or severely limiting food advertising to kids can be helpful. Another suggestion is to prohibit in-school marketing of food products, including offering food products for sale in vending machines and cafeterias.
1. World Health Organization (2018). Healthy Diet. http://www.who.int/news-room/fact-sheets/detail/healthy-diet
2. Jacobson, M.F, Krieger, J, and Brownell, K. D. (2018). Potential Policy Approaches to Address Diet-Related Diseases. Journal of the American Medical Association, 320, 341-342. https://jamanetwork.com/journals/jama/fullarticle/2686890?guestAccessKey=b9988311-7fea-40f0-b7e0-8bf9cc8ebe82
3 Mozzafarian, D. et al (2018). Role of government policy in nutrition – barriers to and opportunities for healthier eating. British Medical Journal, 361, k2426. doi: https://doi.org/10.1136/bmj.k2426 (PDF: https://www.bmj.com/content/bmj/361/bmj.k2426.full.pdf)