In this episode, Kelly Brownell speaks with Jerold Mande, CEO of Nourish Science, adjunct professor at the Harvard School of Public Health, and former Deputy Undersecretary for Food Safety at the USDA. They discuss the alarming state of children's health in America, the challenges of combating poor nutrition, and the influence of the food industry on public policy. The conversation explores the parallels between the tobacco and food industries and proposes new strategies for ensuring children reach adulthood in good health. Mande emphasizes the need for radical changes in food policy and the role of public health in making these changes.

Transcript

So, you co-founded this organization along with Jerome Adams, Bill Frist and Thomas Grumbly, as we said, to ensure every child breaches age 18 at a healthy weight and in good metabolic health. That's a pretty tall order given the state of the health of youth today in America. But let's start by you telling us what inspired this mission and what does it look like to achieve this in today's food environment?

I was trained in public health and also in nutrition and in my career, which has been largely in service of the public and government, I've been trying to advance those issues. And unfortunately over the arc of my career from when I started to now, particularly in nutrition and public health, it's just gotten so much worse. Indeed today Americans have the shortest lifespans by far. We're not just last among the wealthy countries, but we're a standard deviation last. But probably most alarming of all is how sick our children are. Children should not have a chronic disease. Yet in America maybe a third do.

I did some work on tobacco at one point, at FDA. That was an enormous success. It was the leading cause of death. Children smoked at a higher rate, much like child chronic disease today. About a third of kids smoked. And we took that issue on, and today it's less than 2%. And so that shows that government can solve these problems. And since we did our tobacco work in the early '90s, I've changed my focus to nutrition and public health and trying to fix that. But we've still made so little progress.

Give us a sense of how far from that goal we are. So, if the goal is to make every child reaching 18 at a healthy weight and in good metabolic health, what percentage of children reaching age 18 today might look like that?

It's probably around a half or more, but we're not quite sure. We don't have good statistics. One of the challenges we face in nutrition is, unfortunately, the food industry or other industries lobby against funding research and data collection. And so, we're handicapped in that way. But we do know from the studies that CDC and others have done that about 20% of our children have obesity about a similar number have Type 2 diabetes or the precursors, pre-diabetes. You and I started off calling it adult-onset diabetes and they had to change that name to a Type 2 because it's becoming so common in kids. And then another disease, fatty liver disease, really unthinkable in kids. Something that the typical pediatrician would just never see. And yet in the last decade, children are the fastest growing group. I think we don't know an exact number, but today, at least a third, maybe as many as half of our children have a chronic disease. Particularly a food cause chronic disease, or the precursors that show they're on the way.

I remember probably going back about 20 years, people started saying that we were seeing the first generation of American children that would lead shorter lives than our parents did. And what a terrible legacy to leave our children.

Absolutely. And that's why we set that overarching goal of ensuring every child reaches age 18 in good metabolic health. And the reason we set that is in my experience in government, there's a phrase we all use - what gets measured gets done. And when I worked at FDA, when I worked at USDA, what caught my attention is that there is a mission statement. There's a goal of what we're trying to achieve. And it's ensuring access to healthy options and information, like a food label. Now the problem with that, first of all, it's failed. But the problem with that is the bureaucrats that I oversaw would go into a supermarket, see a produce section, a protein section, the food labels, which I worked on, and say we've done our job. They would check those boxes and say, we've done it. And yet we haven't. And if we ensured that every child reaches age 18 at a healthy weight and good metabolic health, if the bureaucrats say how are we doing on that? They would have to conclude we're failing, and they'd have to try something else. And that's what we need to do. We need to try radically different, new strategies because what we've been doing for decades has failed.

You mentioned the food industry a moment ago. Let's talk about that in a little more detail. You made the argument that food companies have substituted profits for health in how they design their products. Explain that a little bit more, if you will. And tell us how the shift has occurred and what do you think the public health cost has been?

Yes, so the way I like to think of it, and your listeners should think of it, is there's a North star for food design. And from a consumer standpoint, I think there are four points on the star: taste, cost, convenience, and health. That's what they expect and want from their food. Now the challenge is the marketplace. Because that consumer, you and I, when we go to the grocery store and get home on taste, cost, and convenience, if we want within an hour, we can know whether the food we purchased met our standard there. Or what our expectations were. Not always for health. There's just no way to know in a day, a week, a month, even in a year or more. We don't know if the food we're eating is improving and maintaining our health, right? There should be a definition of food. Food should be what we eat to thrive. That really should be the goal. I borrowed that from NASA, the space agency. When I would meet with them, they said, ' Jerry, it's important. Right? It's not enough that people just survive on the food they eat in space. They really need to thrive.' And that's what WE need to do. And that's really what food does, right? And yet we have food, not only don't we thrive, but we get sick. And the reason for that is, as I was saying, the marketplace works on taste, cost and convenience. So, companies make sure their products meet consumer expectation for those three. But the problem is on the fourth point on the star: on health. Because we can't tell in even years whether it's meeting our expectation. That sort of cries out. You're at a policy school. Those are the places where government needs to step in and act and make sure that the marketplace is providing. That feedback through government. But the industry is politically strong and has prevented that. And so that has left the fourth point of the star open for their interpretation. And my belief is that they've put in place a prop. So, they're making decisions in the design of the product. They're taste, they gotta get taste right. They gotta get cost and convenience right. But rather than worrying what does it do to your health? They just, say let's do a profit. And that's resulted in this whole category of food called ultra-processed food (UPF). I actually believe in the future, whether it's a hundred years or a thousand years. If humanity's gonna thrive we need manmade food we can thrive on. But we don't have that. And we don't invest in the science. We need to. But today, ultra-processed food is manmade food designed on taste, cost, convenience, and then how do we make the most money possible.

Now, let me give you one other analogy, if I could. If we were CEOs of an automobile company, the mission is to provide vehicles where people can get safely from A to point B. It's the same as food we can thrive on. That is the mission. The problem is that when the food companies design food today, they've presented to the CEO, and everyone gets excited. They're seeing the numbers, the charts, the data that shows that this food is going to meet, taste, cost, convenience. It's going to make us all this money. But the CEO should be asking this following question: if people eat this as we intend, will they thrive? At the very least they won't get sick, right? Because the law requires they can't get sick. And if the Midmanagers were honest, they'd say here's the good news boss. We have such political power we've been able to influence the Congress and the regulatory agencies. That they're not going to do anything about it. Taste, cost, convenience, and profits will work just fine.

Couldn't you make the argument that for a CEO to embrace that kind of attitude you talked about would be corporate malpractice almost? That, if they want to maximize profits then they want people to like the food as much as possible. That means engineering it in ways that make people overeat it, hijacking the reward pathways in the brain, and all that kind of thing. Why in the world would a CEO care about whether people thrive?

Because it's the law. The law requires we have these safety features in cars and the companies have to design it that way. And there's more immediate feedback with the car too, in terms of if you crashed right away. Because it didn't work, you'd see that. But here's the thing. Harvey Wiley.He's the founder of the food safety programs that I led at FDA and USDA. He was a chemist from academia. Came to USDA in the late 1800s. It was a time of great change in food in America. At th...