my name is javana kidos I am the events manager at the USC Soul price school public policy price presents is the USC price school's Premier webinar series about issues confronting society that shape our daily lives each webinar features experts from not only the USC Soul price School of public policy but.
Across USC as well as those from other universities government business and not for-profits today's discussion titled food Foolery will be moderated by Jenny caner professor at the USC price school though the audience will not be able to ask questions verbally we encourage you to submit them in the Q&A function at the bottom of your screen and panelists.
Will respond to as many as possible now I'd like to turn it over to Jenny caner thank you thanks so much Vanna hi everyone I'm Jenny caner associate professor professor at the price school public policy and I'm very excited to be moderating this amazing panel so let's get started it's January and people are talking about new beginnings and diets.
And the Super Bowl but since a nerdy Professor is maybe not the best choice to talk about the Super Bowl today's webinar will be on the food and the dieting part so we don't have a ton of time but just an hour so my goal in the next hour is two things first I would love for all of us to get a better understanding about why we the public.
Are so confused about food and nutrition and second i' like for us to find out what can be done about it both what we can do as regular consumers but also what broader systemic changes might be required now I want this to be an awesome webinar for you but I'm going to need your help so towards the end of the webinar we will have about 10 minutes.
For Q&A so think of some questions whatever you'd like to have answered put them in the Q&A window as the things occur to you through the course of the panel and Vanna and the team behind the scenes will be collecting your questions and we'll be answering them at the end so let me introduce our panelists our first panelist is Dr Michael gorin.
He's professor at the USD tech school of medicine he is he holds the Dr Robert C and Veronica Atkins endowed chair in child obesity and diabetes and among the many hats he wears he's director of the Southern California Center for Latino Health his book proof looks at the hidden danger of sugar for Child Development and what parents can do.
About it welcome Michael our second panelist is Dr anap bapu Jenna he's the Joseph P new house professor of healthc care policy at Harvard Medical School in addition to being a physician he's also an economist and host of the fre economics MD podcast his recent book random acts of medicine shows how medicine really works and also.
How it can work better welcome Buu thank you our third panelist is Miss Sheila Kaplan she is a prize-winning journalist and former public health reporter for the New York Times and Stat news her work has been nominated for several news and documentary Emmy Awards and she was also part of the 20121 piter prizewinning New York Times team who won.
For their coverage of covid-19 she's currently working on a documentary film for ABC News and Hulu on a dietary herbal supplement welcome Sheila thank you and our fourth panelist is Dr Peter Lori he's president and executive director of the Center for Science and the public interest many of you know the center it.
Is the leading consumer advocacy group for improving the food system and supporting healthy eating and among his many past lives and prodigious work he was at the FDA as associate commissioner for public health strategy and Analysis worked on many Food Drug device issues welcome Peter thanks for having me so let's get started food right it's a.
Big subject it's kind of like having a webinar on love or bad taste in music like you could go on for days so we're going to need to narrow things down a little bit and you all are in different lines of work with some relationship to food and nutrition so I'm going to ask each of you starting with Sheila what confusion related to food or dieting do.
You see most frequently so like what's the one misconception that annoys you the most that you really really want to clear up okay um when people see the word natural they think something is healthy or safe and that is not always true um arsenic is natural lead is natural you don't want to eat them um and I think um you know that's uh that.
Can be very dangerous and and the other thing is that too many people think that if a product is on the market it's safe um so people assume that dietary supplements are safe herbs are safe um people don't realize that the FDA doesn't test many things at all hey thank you Sheila all right let's go to Michael Yes uh thank you and welcome.
Thanks for having me on this panel uh I you know it's a long list but I think the first thing that came came to mind when you started saying that was just that there's so many Domin voices and dominant views on this or that diet being the diet and you know I think at the end of the day there's not going to be one diet for everybody I.
Think everybody has their own unique issues their own dietry preferences their own taste preferences their own health issues so I think there's not going to be uh one diet or One supplement that's going to be a Magic Bullet for everybody I think it's there's too much variation an individual needs for that.
To be the case thank you Michael so Sheila definitely on The Branding there's sort of some marketing issues Michael heterogen just people are just very different so there's no single right answer um B what do you think what's your Bugaboo first of all I never thought a webinar would make me hungry but now.
Now talking about food you know I I would almost step back a little I think food is part of a broader conundrum that we see in sort of Science and then the interpretation of science you could put things like different forms of physical activity other lifestyle behaviors food is just one of those things where there's a lot of interest in generating.
Scientific evidence but the quality of it is really quite low and because the quality is low it you know it leads people to think that certain things might work for their health uh that perhaps work but you just don't know that they do and the the bigger problem for me is that if you find some evidence out there might not be good and if.
You're not doing something you think to yourself well I'm doing something wrong because I'm not following the keto diet or this particular diet when in fact that may not be true at all so I think people have to have a little Grace and say you know what's out there may not be correct so just acknowledge the uncertainty lack of knowledge um.
Peter where to start really um I'll start where where Sheila began is with the with the dietary supplement industry I mean this is just a very very frustrating frustrating industry I mean it it you know 1994 was about a full billion dollar industry now it's about a $60 billion do industry thousands of products that have come on the market uh.
Very few of them have any evidence at all and those that do mostly prove that they don't do anything at all um and yet people are forking out $60 billion doll out of their back pockets right no insurance um for these products that aren't doing them any good and they um have a belief somehow that a dietary supplements or somehow I don't know what.
Countercultural sticking it to the man I'm not sure quite what it is um but there's some idea that you know even though these products are often poorly made barely regulated and you know a washing claims that can't be supported that somehow that's better than a drug um you know that's just extraordinary to me and I part of the reason is that you.
Get a little bottle and it's got a bucolic label of a cow and a you know in a red a red barn and how that you know conveys credibility to people when instead they should be listening to Babu who's telling you that what you really need is evidence right so everyone listen listen to Babu um so just want to follow up on.
A couple of of different threads here so um we does it so let me just throw this out here as I was thinking about this you know good bad things which is what we think about chocolate may be good maybe bad um does it um does it make sense to talk about something as would would you be willing to say are there unambiguously bad things so Peter.
You talked about things that you know are on the market but that don't have any effect maybe don't have the anticipated effect are for any of you are there unambiguously bad things some Hill you're willing to die on where you're willing to say absolutely no one should be eating lard or bangers and Nash Peter I'll I'll start with you.
Since you you know I I have the right accent for this so I'll speak up for bag look the the truth is that you know with the exception of uh you know a carcinogen that gets by the FDA and some do um most things in moderation are going to be okay um you know the the that's the difficult part I mean the real challenge here is to convey to.
People the complexity of diet to somehow on the one hand push them in the direction of those things that are likely to benefit them like more fruit and vegetables you know legumes so on Less in the in the direction of red meat um but at the same time not be so rigid about it that people feel guilty with every bite that they place in their.
Mouths that's the difficult part on the one hand you want to push them over all in the right direction on the other hand you don't want them to obsess about each of the elements of that direction that's that's complicated and hard to Michael do you want to talk more about you introduced the issue of complexity and heterogeneity do you want to talk a.
Little bit more about that well um if it's okay I can just follow up on what Peter was saying because in response to your question you know I don't know if I could pick any one particular item but I did write a book about sugar because um especially for children uh sugar has so many detrimental effects but that's not to say that children or.
Adults should never eat sugar again because let's not forget also that food is meant to be enjoyed and is part of our culture so we also shouldn't lose sight of that so the whole sugar prooof philosophy is to say to help parents be more aware of hidden sugars and the effects of sugars on kids development so that.
They can um basically navigate through the very complex food environment so if I had to choose one thing it would be sugars and that also now includes dietary uh non-nutritive sweeteners um which are kind of infiltrating the food supply as well very rapidly and have multiple detrimental effects so I think for me if.
It's one thing it would be sugars and sweetness of foods uh but not to the point of saying you should never eat uh sugar again um just kind of modifying uh as best as possible I see just one quick follow up on that so does that also include complex carbohydrates or is it mostly around just simple sugars your.
Recommendation I'm mostly talking about added sugars um to be even more specific 70 to 80% of processed foods contain some type of added sugar uh so so then this gets into the whole issue of processed foods versus Real Foods so hard to beat real foods uh as a way to meet a healthy diet thank you I hope to get to the.
Processing part uh later on in the SE seminar uh Sheila Baku any any additional thoughts yeah I um uh one thing that I found um very disturbing was going to the um one of the nutrition Association Expos uh where the sugar Association had a coloring book for kids that they were giving out and it was built around a.
Trip with two characters sugar cane and sugar beat and um they said sugar came would say hello we make food with lots of vitamins and minerals taste good and sprinkle sugar on carrots and peas or add it to fruit salad or vegetables and then sugar beet would say yes because it's all natural you can consume it with confidence wow I think I just saw.
Michael's head blow up just then but um pap any thoughts cop of that the other thing I would kind of throw into the mix would be uh alcohol I think most people agree that in high amounts alcohol is is not good for you for a number of different reasons but.
The jury is a little bit out on whether or not moderate amounts of alcohol uh are good or bad for you because there's a number of epidemiologic studies that suggest a beneficial association but then there's other studies which rely on genetic variance and some individuals that make it distasteful for them to take alcohol for example if you have a.
Flushing reaction when you take alcohol and that's sort of random and you're you know your cousin doesn't have that reaction or someone who's the same race and at this as you does not have that reaction but you do two things might be true one is you might be less likely to take alcohol and two is that might confer some benefit to you which is what.
Some studies suggest so that's an area where I think there's a little bit um of an issue of interpreting the evidence but one where at high levels I'd be worried about a lot of consumption right thank you so yeah so nothing you know outside of carcinogen to rule out but some things maybe to be a little bit more wary about um so we've covered.
Thank you for that we've covered a lot of different types of misconceptions related to you know dietary supplements certain kinds of foods certain kinds of diets and I think that's just really the tip of the iceberg and so my next question is why are there so many misconceptions and so we have they sort of big systemic.
Issues and also lower level issues but I'll start with Michael with sort of maybe and maybe Baku alluded to this too uh does this have to do with sort of the state of our science like our current biomedical models are we kind of in the equivalent of like the blood liing leech stage with nutrition science and that's why we're seeing all this nonsense as.
Well as hopefully you know sense with evidence I think there's probably multiple factors of play I mean the science is very difficult in this space you know trying to prove that some particular diet or even some particular um dietary factor is healthy or not Across the Life Course is extremely difficult you know I mean the ultimate.
Test is a randomized clinical trial but you know you you can't do a randomized clinical trial for 20 30 or 40 years um modifying one particular aspect of the diet and keeping everything else constant so the studies are just very difficult and very expensive to do so we often get mixed findings discrepant findings and you can't just look at one.
Particular study even if it is even if it is a robust trial because there there may be confounding factors there may be limitations and so this the study of the SC of nutrition science to do those studies is extremely difficult in some cases I might even say impossible if you wanted to look let's say at the lifelong.
Effect of diet X versus Diet y you just can't do such a study so we have to kind of look at the the the bigger picture and that's complicated and there's not an easy answer but yet on the other hand we have loud voices on Instagram and social media proclaiming um this or that that diet or this or that supplement is the best.
Thing since slice spread and those people could have millions and millions of of followers and suddenly you know you've made a dietry trend happen without any particular science behind it so it's just really really hard to do um to do the kinds of Ideal trials that we would want and I want to get back to that um in a second uh but I just want.
To ask Peter Baku you're both Physicians would how would you assess the current state of the science itself sort of separate from research design issues well you know I spent more of my life on drugs than on food that maybe doesn't quite sound right but I know what you mean you know what I mean um the uh so when I sort of came.
More to the nutrition field I have to say is overall a kind of a sinking feeling that you feel when you when you come into this area um and some of it are for the reasons that Michael gave um that it's just very difficult to do these studies there you need a lot of people you have to follow them time um unlike drugs there are substitution.
Effects where somebody eats a bit less of this they'll eat a bit more of that and vice versa and you know you most of it is ascertained through these questionnaires that depend in turn on dietary recall and people's recall isn't very good so um all those things make it difficult but um overall though compared to other scientific.
Areas uh I I do think often the science is weaker um I think the randomized trial though is finally making inroads into nutrition just in the last you know 10 or so years I think that these studies that were set to be impossible in nutrition people are suddenly finding a way and we're getting more of them and uh oftentimes that they turn out to.
Debunk what the observational studies had actually seemed to show um so you know the the parade negative randomized Trials of vitamins for example is you know practically endless you know after a previous parade of observational studies that seem to suggest benefit so what I really find hard to um to take really is given all of this given all of.
The difficulty given all of the experience that we have why so many people are so sure that's the part that I find frustrating if the if the evidence is weak then you have to acknowledge that and you shouldn't speak as loudly as people do you should speak in proportion to the strength of the evidence underlying what you're saying.
But people feel an obligation to provide strong answers there's a market for it for sure on the internet and as a result people respond and we get a lot of people who appear to be sure of themselves it's just that they might be wrong yeah I could appla they they have a conflict or a vested interest yeah stay tuned we will get to.
That um uh so relatedly I know bapu back in the day I saw as we're sort of talking about science and how we're accumulating knowledge and just how hard it is but back in the day I saw you on Med Twitter before Twitter kind of you know took a turn and I saw you tweet some pretty Choice things about nutrition science um could you talk more.
About your critiques of food studies how they're designed we've just heard it's just really hard to even do an RCT where people and you know where you can actually control diets over long periods of time what what other sort of design issues are you do you have your be in your Bonnet about first of all I thought I deleted those tweets that's.
A I mean I think this alluding to what Michael said it fundamentally it's a difficult problem to study using observational data so for example if you look at people who eat a Mediterranean diet and you compare them to people who don't and you try to ascribe any differences in health outcome comes between those two groups to the diet.
That that one group ate you got to make sure that they're not doing other things differently maybe they are taking their medications regularly maybe they're exercising more maybe they're sleeping better there's lots of different things that they could be doing which preclude you from saying oh this Mediterranean diet caused these Health outcomes the.
Way that we typically try to address this problem which is sort of endemic in nutritional science and sort of all the literature on looking at how lifestyle behaviors affect effect Health outcomes if you do a randomized trial now Michael's point is a great one is that could you really say I'm going to vary this one uh nutritional exposure in one.
Group of people and measure it for 30 years I think that would be impossible to do or at least really difficult but I think that there are path forward for example there's a lot of surrogates that we think are important to health so you could look at things like cholesterol panels weight osity blood pressure um so I don't think it's a foregone conclusion.
That we can we can get good insights into what might be the health effects of diets or other lifestyle behaviors in a in a randomized trial context the other point that I would make though is that really it's about incentives you think about why does a drug company create a randomize control trial they do it because they're required to do so they.
Have uh you know an evidentiary requirement that says look if you want to sell your drug you've got to provide this information so who has the incentive to provide information about the Mediterranean diet nobody does so this is really a place where I think governments can come in and really you know meet the challenge they haven't.
Done a great job of that yet even though this is to me like an incredibly important thing it's something that people think about all the time what should I eat how much should I exercise how should I exercise those are sort of fundamental questions where there's no private entity that has the in incentive to develop that knowledge thank you for.
Bringing that in um yeah I mean there's no big Brock isn't out there sort of running the trials right so uh but but now I'm a little worried like does that mean you know the fact that you know it's just hard to control what people eat over long periods of time does that mean that we just can't know or how what what's the what's the second best.
Here Michael what what do you think is the second best in terms of how we can make progress in this area well I I I mean I don't know I think um what's second best what what what do you mean I mean we can't get the RCT that we want for 40 years what can we well you know it's it's a combination you have to look at the that's what I was saying you have.
To look at the kind of entirety I mean including even animal studies which are somewhat still informative in terms of mechanisms and you know it it and that that's what makes it so complicated is because once you start to look at the kind of entirety of of of the evidence from trials at the top to animal studies at the lower end of the evidence.
Base it's always going to be a little muddy in terms of what what what the data is actually pointing to so I think I mean I think cohort studies have been very good which are not informative on absolute causation but do Show Association um I think core studies are good but you have to follow people for a long time and that's difficult and.
There's been some great examp examples of long-term coh heart studies in big populations that have been really super informative in terms of um di because also like I mentioned earlier it's not going to be one size fits all so you have to look at as Papu said you know other contextual factors like what people what C what.
Demographics what other environments and so on we're also involved so I don't know if there is an absolute choice for the second level but it's it's uh probably Association cohor studies and looking at the bigger picture yeah I'm kind of getting the sense that maybe multiple pieces of evidence that point the same direction.
Different outcome measures might be informative um given that we can't sort of get to the the gold standard um of research that we might want um so this has been all really great Focus on researchers and Healthcare Providers I would now like to bring in Sheila um and have her talk a little bit about the role of journalists and reporters I mean.
Most people are not sitting around reading for fun jamama or New England Journal they're getting the news from people like you and they read one day coffee is good another day coffee causes cancer what how should we think about the role of journalists and how well do you think journalists are are doing in this area.
I think I think the large newspapers are doing very well I think they realize how important coverages of nutrition and I think they in the last few years I've seen them move away from highlighting you know the new study dark chocolate great dark chocolate bad um you see less of that in the post the times um you know and and the TV broadcasts tend to.
Follow what what the newspapers do I think um but I think one thing that isn't happening as much as I'd like to see is you know when reporters cover studies we need to report on the funding and um we need to say you know this study was funded by The Chocolate Company you know we we need to give people that.
Perspective um and I think I think rep should cover peer review studies you know make sure they're from legitimate journals um and um you know and point out the conflicts of interest um one one of the things um that that I ran into when I was at the times was I did a story on uh the then CDC Chief.
Brenda Fitzgerald who had been a health official in Georgia and she had made a deal with uh cocacola company to provide funding for an after school program um to get kids to exercise and it was called like Georgia shape or something and it said you know to to solve obesity you need to move you need to have.
Exercise and movement and eat lots of fruits and vegetables but it didn't say a word about sh and um when we wrote about this she you know got in some trouble and ultimately changed the the policy but um I think I think that reporters really need to focus on um what our old friend Jonathan Marx would call the public private Partnerships and.
Um you know really help readers understand when a story is legit and and and not to put people on who on or quote them who are just going to say you know this is a great study from now on no one should drink or no one should you know eat eat a certain food you have to you know the the people who call and wander be quoted are often the people who as.
Michael said you know or Peter don't don't know you know they they think they're experts but they can be wrong and we have to watch out for them well thank you for that very sophisticated analysis of sort of what's happening and news so at least one part as I'm sort of trying to think through so one part seems to be you know we shouldn't be.
Just running towards the latest study right that that's that the focusing on that is going to lead us astray we short of uh reporters maybe need to be also focusing on the bigger picture sort of what it what the state of the literature is and not just sort of the newsbreaking event um and then as you brought in and I hope we'll get a chance to also talk.
More about with Peter as well is conflicts of interest like who is funding the study who has who has a particular vested interest and uh reporters really digging into that and Reporting reporting that so that the readers do know um one tiny follow up on that from the medical folks I'd like to hear how do you think that journalists.
And this be Michael Peter Papu do you think journalists accurately represent the findings of the studies are are they doing a pretty decent job with with that you may speak freely we're in the bubble well I'll tell you something interesting when during covid of course we saw a lot of Mis misinformation out.
There and we decided to do a study that looked at the prevalence of misinformation in in effect the traditional media right we looked at the top 100 sources and we focused in on Co vaccination alone and and we had some you know Boolean algorithms that we could run and then we had another portion where we actually looked at the.
Articles themselves looking for misinformation turns out that at least in these more of the top more of the traditional media prevalence of misinformation is actually fairly low it was much under 0.1% um now so there's much more that is accurate than inaccurate um at least when it came to co U.
Vaccination however that tiny fraction that is inaccurate you know can be enormously boosted right by algorithms and so forth and so the reach of some of these inaccurate articles was in the hundreds of thousands even sometimes the hundreds of millions of people um that you can reach so that that's the difficult part you know if it was all.
Misinformation that would be one thing you'd go after all of it but if it's a needle in a Hast stack that is actually the source of information that somehow you know becomes some giant needle over time um that's very difficult to to stemp out um so I I think that's a large part of the problem rare but.
Dangerous thank you Peter um I think the bigger issue is also not in the regular media but in social media I think that's where there's a lot of um misinformation and miscommunication happening I would say the following you know I don't have a s systematic analysis of all these issues but my sense is that the the articles.
That are written in the mainstream press they Hue pretty closely to what the the studies show or the studies report to show and I think the the the main step is not that translation that to me is not the issue the news is out there the journal has decided to publish a study I think that the major problems are why are investigators working on studies.
Where it is very difficult to say that something causes something else so what are the incentives in place for a researcher to conduct that study and then the second issue is what are the incentives in place for a journal sometimes a very prestigious journal to accept that that publication um or accept that study for publication I.
Think that more of the problem focus is there and I and I think part of it is that there's just an appetite for this kind of information whether it's high quality or not it's just sort of like always in the news we like to hear you know you mentioned you joked about coffee good coffee bad I mean there's literally a study like that every few.
Weeks and they you know they oscillate back and forth you can't keep track uh and I asked myself well why is that who's doing the studies why are they doing them and what are the incentives that are leading them to do them and I think all that stuff doesn't sit well I think it it probably for the most part operates differently than people think.
So yes there are times that there are truly dishonorable people who report something as positive when it's actually negative of vice versa yes that can happen um certainly you can shade the data here or there the larger problem related to conflict of interest is which questions are being asked and the the research agenda is being driven by these.
Conflicts and certain questions that would be unquestionably interesting to the public and of great Public Health importance you know are having a hard time getting funded but some other obscure thing that offers the possibility of profit you know is something that will you know up support in no in no time at all so it the the.
The whole research agenda is distorted in the first place this of course is not unique to food and then you have you know what Papu is starting to talk about what what happens on the dissemination end it could be that the New York Times is you know Absol you know absolutely above board and always accurate and that was of course the case when Sheila was.
There but but but but how is it that a given study comes to Sheila attention right why why why is it that she hears about that you know what is the engine that creates that some of that Jenny I'm sorry to say comes from universities right which have got PR departments that are pushing sometimes trivial studies being done by their faculty members.
Because they can get attention for the University by getting that unimportant study into the newspaper and it's more likely to do so if it's about dark chocolate right and so you have an engine that is set up to often emphasize the trivial um and the journalists are responding to that um but but in the end what is received by.
The consumer is the product of all of these distorting forces and what comes out the far end of the pipeline is something very different than what would be ideal from a public health point of view and so that seems to be like a gap that policy makers the government can step into but I wonder sort of Boose Point um but I wonder I mean it takes a.
Lot of money to run these trials and you we I think many of us in on this webinar know that the reason industry funds say the phase three trials for drugs is because the government just doesn't even have the budget to to run these big trials so what can policy makers do is it do you think it is mostly in funding Peter or are there other sort of.
Regulatory um levers that can be used well certainly um from a claims point of view right what you get to say about a given food on the on the market well that is within the realm of of what Regulators do uh you so you know the the most of it is regulated by the Federal Trade Commission Federal Trade Commission uh basically regulates on a.
Quote false and misleading standard so you really have to go pretty far right in order to to Mis brand your product so the you can can you can skirt pretty close to the line and get away with it and one reason you can is that the federal agencies themselves you know have have been undefended chronically and so they don't have the ability to go.
After all the claims that they see I mean I you know at FDA I know we saw vastly more inappropriate claims than we could ever go after and so what you would do is you would try to select you know really representative infractions right ones that either were a kind of infraction that many other companies were engaging in um or about a product.
That was you know highly influential or sold very heavily in some way where you could send one or two letters on let's say CBD and then the whole CBD industry you hope would hear that so but all of this is a reaction you know to poverty in effect right it's a Poverty of authority and it's a Poverty of cash for the agencies in which they're always.
Behind the eightball and the companies know that and they'll keep on pushing the limit because the truth is that they'll probably not get busted thank you um any other any other last thoughts on on this issue before we move on to maybe let's move on to the the really the part that people are really interested in so we we've looked at all.
These different causes of the problem and now we get to the part where we ask what can we do about it and just so you know we have about 20 minutes to solve this problem so while the panelists are thinking about this I just want to mention to the audience that we'll be taking again questions in 10 minutes so fire up your questions and put them in.
The Q&A um and uh so I just want to start with Physicians you know the Peter Buu Michael Physicians researchers nutritionists other Healthcare Providers what's thinking about the different roles that people in the ecosystem play so Physicians and researchers Healthcare Providers what can they do to help reduce patient.
Confusion we can start with with Buu it's very confusing uh I I think what I would say I mean you know if someone asked me about a particular new diet or fat diet I'd say you know most things probably okay in moderation some things very dangerous even in in um low amounts or or moderation but you know you know I.
Focus on things like are you physically active is your weight in a good place are certain metabolic parameters that we would care about like blood pressure or cholesterol or hemoglobin A1c those things are not perfect but they're sort of reflections of in part what you're doing with your lifestyle what are you what are you eating and so if those.
Things are doing well and someone said a good eight wait I'd say do what you're doing I I don't know that there's a magic fix here um I do want to mention one thing that just remember there was a study not too long ago in Jam Internal Medicine by uh Joe Doyle and MI it and others where they they looked at essentially the effect of prescribing.
Food um to people this was just something that's sort of like a thing that people talk about in medicine like the doctor could just prescribe a healthier diet to a patient and that might influence their their health outcomes and basically what they found was there's no real effect of that so that's an example of something that.
Feels sort of sexy something that people talk about something that observational data suggests might work but if you put it to the test in a randomized trial doesn't really seem to to do much and do you think most Physicians could be doing what you're doing bapu are they sort of are they on the on the ball with you know giving advice with sort of trying.
To reduce the uncertainty for their patients I think so but I don't think I don't think this is coming up honestly at the physician level I think this is happening out way outside the doors of the physician's office there's a lot of things that Physicians spend time with with patients that are not related to sort of diet and exercise things things.
That are are very difficult to control in a 15 20 minute discussion with the patient so I I don't think that it comes to the Forefront in clinical practice that much for me I I found the and I hate to say this the experience of clinical uh you know diet Counseling in the in the in the office uh rather frustrating um people have a hard time.
Complying for variety of reasons including the overall food environment which is inhospitable and makes it difficult for you to you comply with even the best medical advice right given the plethora of you know bad foods that are around um but yeah I just didn't find it that rewarding people didn't comply as much the results weren't as.
Good as um I wish they had been and that's honestly how I got into public health um that's when I decided that if you really wanted to make you know a difference you had to look at you know whole populations and that for me anyway um you know this kind of one by one approach was not really a good use of my time or at least my skills such as they.
Are um so you know we put out a magazine that tries to do some of this called nutrition action uh you know that's one way of getting out information but really I think um for us the it's really you I'm not sure that the solutions really reside in the doctor's office it's a rather I think cost ineffective way of trying to bring about change in.
This area speaking of then okay so doctors maybe they're off the hook for now um what advice would you have for the individual consumer yeah you know how to the to the extent that consumers can do something I mean uh you mentioned a lot of the problem is bigger it's just who's funding who has the incentives to be.
Doing these studies um what types of strategies have you seen be successful U Michael I know you deal with you know parents and their children um any any advice that you would have for consumers adults or children yeah I mean I think think you know we were just saying by the time we get to Physicians it's it's too late we need to work with.
Communities and families in particular um if we can so we're doing a lot of work now in our Southern California Center to work with Community groups in collaboration kind of a bidirectional collaboration because they need help from us and and and we need help from the community as well in terms of Designing and.
Implementing um studies I think the days of research are just saying oh I'm going to do a study on X because I think it's going to work the best are kind of um are kind of Disappearing and we we need to instead work directly with communities and say okay what are the real issues and what is our best chance of success with an intervention so we.
Need to kind of develop and design and Implement strategies with the with the community uh in mind but working with families I think the message is is is is to eat more real food I mean I think it's very hard to argue with that that really at the end of the day it's the overabundance of processed foods that are causing a lot of the chronic disease.
Problems that we're trying to deal with and one way to to do that is try and get people to just eat Whole Foods to make their own Foods and find ways to get families to enjoy the cooking process to get kids involved with that process too as early as possible so that kids can grow up with that culture of uh deciding what to eat.
And helping to prepare it uh I think these strategies work um quite well um as opposed to telling people you can't eat that you can't eat that um it's more about just trying to get people to eat Whole Foods which I know it's not easy it's time consuming the perception is it's more expensive to eat healthy but I don't.
Think that's necessarily true I think we need to kind of overcome that myth that healthy eating can be affordable because let's also not forget about the fact that what we're talking about the chronic diseases of obesity diabetes liver disease these are very uh prominent among lowincome populations and under represented populations so.
We're really dealing with major disparities here that need to be addressed and that it's going to come back to Federal policies such as Wick and snap that we haven't talked about that also need to be addressed thank you Michael super super helpful advice I think we now is a good time to turn to audience questions I see.
We have quite a few so I apologize in advance that we might not be able to get to all your questions but um just want to start off actually maybe on on Michael's point of processing and the US dietary guidelines so what do you think about the US dietary guidelines there's some new recommendations about to be issued in 2025 and I guess the.
Scuttlebut is there's going to be a shift from focusing on individual nutrients to how foods are processed and Ultra processing so I wonder um General thoughts about the AR guidelines should we you know follow them slavishly are they just junk um somewhere in between I think the dietry guidelines.
Overall are quite U useful um not necessarily to be followed to the tea um but I think the move towards processing of food and Whole Foods is is is a good one because I think we've long been been too long obsessed with specific nutrients like dietary fat dietary sugar but it's all about the Whole Foods I'm also encouraged by the fact that dietry.
Guidelines are also moving towards younger populations um as well um because let's also remember that the whole concept of we are what we eat starts with what our mothers at and what we were consuming when we were infant so I think we haven't talked much about that early nutrition also critically important I.
Think diet guidelines are beginning to recognize that too um related to question the chat um what do you what do you think of the food pyramid anyone Peter Papu well for one thing it doesn't exist um so um that's easily dispensed with um it's it's it's really it's a plate now um my plate sort of set you know flat as.
It were so industry didn't really care much for the idea of the the pyamid because it Place some things on top and some things lower down and uh in their minds that created a hierarchy um so we move to the you know to you know the planer aspect right of the plate um but even that is debated uh it's got a gloss of milk on it um and that's probably uh.
At least in part the the result of lobbying from the dairy industry why is it not a glass of water that would be fine um so uh you know all of this is you know part of what you know USDA puts out so I just want to go back to the dietary guidelines for a second um and say that uh I guess I'll go out and say this in public I I don't actually think.
That the dietary guidelines are going to say that much about processing in the end um my guess is they'll that they'll punt on this issue and say that more research is necessary which aside from always being true is probably true in this case um the the problem fundamentally is that there is no good definition of what ultr processed food.
Means I mean it's a term that people understand in the way that they understand obscenity or you know pornography right they know it when they see it but when you actually try to Define it it becomes much more elusive right so is it the number of of ingredients um but you know multi-grain bread has a lot of ingredients you know.
Is it certain additives that can't be added yes but that can be helpful right at times uh you know you don't want your food going off in a day or two people are going to get going to get infected you know they're going to pick up pathogens that way right so there are you know it just I I feel like it's a concept that people have a good.
Intuitive understanding for but when you start to think about it in scientific terms or in regulatory terms it's a lot harder to get your hands around than um on a slightly different note um someone was wondering what your feedback is on food journaling tracking apps like my fitness pal n ficate um.
Any experience with those and recommendations well I will say we did actually cover some of those uh in our magazine you know over the years we have we have you know reviewed some of those and I'm afraid I can't check cite you chapter and verse here except you send you back to our magazine and find it which is what I should probably do after.
This call um yeah I mean you know they're very often very intensive the you know labor intensive you have to put in a lot of information um and and so that makes it difficult and so it's hard to except for the truly committed to have high levels of compliance that's part of the problem um so yeah that's really for the for devotees I I would.
Say but if you're one of them the way you might be for a Fitbit it might be something that could help you relatedly someone asks and gives a quote quote healthy eating isn't a problem of knowing it's a problem of doing do you agree and if so what are the key Solutions uh let me see the following I don't know what the key Solutions are.
But that was a point I think I wanted to make as well we we had the study a few years ago where we looked at um hypertension weight diabetes things like that um in Physicians nurses and the general population and if this is all an information problem which guidelines food pyramids food plates whatever it is can solve if it's just an information.
Problem you wouldn't think that Health Care Professionals like doctors at the extreme would have similar problems as the general population but guess what they do um they're slightly their weights are slightly less but still significant rates of overweight and over obesity even within a very educated Health Care population and to me that.
Data point says this is not an information problem it's not that people don't know that Ben and Jerry's which I love isn't good for you to eat on a regular basis um it said it's just very hard to do and so I think that the path forward is really to figure out what are the barriers to doing the things that are healthy and how do you reduce those.
And that's not an easy problem um to solve I think it also varies it's probably a bodal distribution on that I think there's probably a fair segment of the population that is is that does not have the information um that that they would find useful on how diet the nutrition is affecting their health this gets back to.
The whole issue of disparities that I mentioned earlier we have a couple of questions about intermittent fasting um any so you know what do you what's your take on that is there or maybe you think they're great and maybe there's a specific kind of intermittent fasting diet that you might recommend I don't have any diets to recommend but I do.
Know about all my cardiologist friends are doing it so that's a yes I think it depends on what your goal is in terms of uh for weight loss I think the evidence is not that convincing and it seems like caloric restriction is probably just as effective but there may be some benefits.
On other aspects of metabolism that will um be beneficial um in terms of things like insulin resistance and cognitive Health um so it really depends individually on what your situation is and what your own goals are thank you we also have a couple of questions on pesticides um GMOs um what.
Should be done about you know fruits to or and vegetables to wash off pesticides you I'll throat to Peter first and Sheila do you have any thoughts well we don't so much work on pesticides so I'll take a pass on that we do work on genetic modification though and uh we certainly do not take a position that all genetically modified products ought.
To be avoided um that seems illogical to me the National Academy of Sciences is already said that they don't see any evidence that GMG products are uh inherently unsafe so what follows from that is that each of these products ought to be individually considered some might turn out to be dangerous some might turn out.
To be beneficial um but what I but but considering them all together um it makes very little sense to me so what we need is a regulatory regimen that is able to look at in a risk-based level at these different products and assess them individually and um because there there there are undoubted possibilities here um that could be clearly beneficial to.
To the public health I mean what if you were able to fortify rice for example with a with a given vitamin right would that would that would be a useful thing or you know increase crop yields all other things being equal that would that would be beneficial so um I I you know we're in favor of you know responsible regulation of of genetically modified.
Organisms I think um there are way too many herbicides and pesticides in food I think the the um chemical industry Lobby has um managed to prevent the EPA from taking the action that the researchers there know needs to be done um one thing they've done is the um the pesticide Industry Group used to be called um the national uh insecticide urb herbicide.
And fungicide Association and then they thought that's too scary so then they became the pesticide Association or something like that of America and now they're the crop Protection Association of America which you know conjures these images of standing over fields of wheat to protect the crops um they're very powerful Lobby I am not um optimistic.
About EPA taking the steps it really should take um especially on neurotoxins and neurotoxicant the chemicals that affect kids uh development of their brains choose choose organic where you can is is you know pretty safe B but I know that can sometimes be more expensive for people yeah right well.
Sadly we're almost out of time time and I'm sorry we weren't able to get to everyone's questions but we will certainly make a record of them for the panelists to consider and in the last few minutes to wrap up I just wanted to get some final thoughts takeaways from the panelists so to each of the panelists if you were Master of the.
Universe what is one thing that you'd want to happen to reduce the confusion that the public has about food or diet or nutrition um let's start with Michael I was hoping you wouldn't choose me to go first we can we can give you a pass Sheila would you like to go I I'll I'll weigh I'll certainly weigh I mean I.
Think um I I I would say we we need to address um early on in life I think we've you know forgotten to teach kids about nutrition we forgot to teach families about nutrition um as well as the uh medical community which is getting a little better I think we just need better information um and knowledge in general.
Through throughout the public on on nutrition and how it's affecting long-term Health I'd like to see um FDA and CDC be better funded so they could do their jobs to protect the public and I would also like to see an enormous movement to cut salt you Peter um well um as Sheila may know we.
Have a petition before FDA to try and reduce uh assault exposure so uh hopefully that will grant your wish um my additional wish in the area of of information which is I think partly what your question was um is we have another petition before FDA on what's called front of package labeling which would summarize the essential information on.
The nutrition fact panel that's the black and white one on the side of the pack and take the essential nutrients from there place them on the front of the pack with an interpretation as to uh whether or not they're too high in a given food and uh we think that would simplify the information and allow even people with lower educational attainment.
To be able to make good judgments and Bak I'll just throw out a research idea as as everybody was talking um part of the challenge here is getting the data and I think about everybody who's in the hospital you know what patients eat because they order things on a list and you can see what they eat they get blood test drawn every day so you could figure.
Out things like what's the effect of salt on you know measures of uh fluid volume in the body there's lots of different things that you could study if we were just a little bit more creative than we are U at trying to answer some of these questions so maybe someone will do that thanks Papu hopefully NIH is listening somewhere there so thank you.
So much for all the great insights and advice um we're sadly at the end of our time I want to thank our panelists for a fun and informative discussion and I want to thank the price Communications team Vanna Gia and lanon who's sort of lurking in the back but really was a prime mover behind this webinar and if you're interested in more of these.
Webinars at the price School of Public Policy the Schaefer Center for Health policy and economics or the kek school of medicine please check out the links in the chat and sign up on the mailing lists and finally I want to thank you the audience for joining in and for your excellent questions I hope you can join us for the next webinar this concludes.