WASHINGTON – What is most of the money – 80% – being spent on since nearly a third of federal spending now goes to health care? Treating preventable diseases, many of which are caused by poor diet, said Senator Cory Booker (DN.J.), chairman of the Senate’s Agriculture, Food and Forestry Subcommittee on Food and Nutrition, Specialty Crops, Organic Products and Research Tuesday.
“Right now, half the US population is pre-diabetic or has type 2 diabetes,” Booker continued. “In 1960, approximately 3% of the US population was obese. Today, more than 40% of Americans are obese and more than 70% of Americans are either obese or overweight.”
Booker’s remarks sparked a nutritional hearing in the United States. He noted that while the country has made some progress in addressing the hunger problem, “it is now facing this second food crisis – one of the food insecurity that too many Americans live in.” Overfed but undernourished, experiencing these appalling rates of disease and premature death. “Although the US is the richest nation in the world,” we have created a nutritional system that relentlessly encourages overeating, literally making us sick and making us feel sick to spend an ever increasing amount of our tax dollars … treat diet-related diseases such as type 2 diabetes, heart disease, stroke, certain cancers, and chronic kidney disease. “
One possible solution to this problem, according to Dariush Mozaffarian, MD, cardiologist and dean of the Friedman School of Nutrition Science & Policy at Tufts University in Boston, is by providing more and better nutrition education for doctors. “The vast majority of doctors say in surveys that they recognize that nutrition is so important to their patients that they want to learn more and not learn enough in their education,” he said at the hearing. “The easy way to fix this is to change the tests. We need to change the US medical licensing exam, the professional agency tests, and the continuing medical education tests that every doctor takes to address the top cause of poor health in to be our country. ” . Shouldn’t all tests have 5% or 8% questions about nutrition? We’re changing the test, we’re changing medical training overnight. “
Including more nutritional issues in admission tests and board exams would go a long way in improving nutritional education for doctors, said Dariush Mozaffarian, MD, of Tufts University. (Courtesy photo of C-SPAN Livestream)
Mozaffarian listed three other ways to prioritize diet:
- Medically coordinated meals. “We need to have Medicare and Medicaid, test, implement and scale medically-tailored meals,” said Mozaffarian. “These are [home-delivered], nutritionally tailored meals for the sickest patients with severe chronic diseases such as kidney failure, heart failure, poorly controlled diabetes and cancer. Research has shown that providing medically tailored meals to these sick patients reduces hospital stays [emergency department] Visits, reduced nursing home visits, and even considering the cost of the program actually saves money – up to $ 10,000 per patient per year in one analysis. “
- Create recipes for people with nutritionally sensitive diseases who can still shop and cook. “A doctor should be able to write a prescription for a fruit, vegetable, bean, or other healthy food item that is partially or fully covered by insurance,” he said. “Prescription drugs, on all evidence, appear to be at least as cost-effective as other treatments such as cholesterol-lowering drugs for the primary prevention of heart attacks.”
- Better reimbursement for dietitians. “Medicare can only reimburse dietitians for advising patients with a very small, limited number of diseases such as diabetes or kidney disease, but not for many other major diet-related conditions such as being overweight or obese, high blood pressure, heart disease, stroke, or cancer,” said Mozaffarian. “In a cardiology clinic, I can get reimbursement if I have a genetic counselor on my staff, but not if I have a nutritionist on my staff. It is time to fix that. “
Senator Mike Braun (R-Ind.), The senior member of the committee, asked the importance of getting the American Medical Association (AMA) to take the lead on this issue, “as opposed to trying to find solutions forcing it through the government – that’s always a bit trickier … How important is it that the AMA goes along with it? “
Patrick Stover, PhD, Dean and Vice Chancellor of Agriculture and Life Sciences at Texas A&M University at College Station, did not respond directly, noting that when he was President of the American Society for Nutrition we “spent a lot of time focusing” . Bring more nutrition into medical education. This is an enormous challenge because every professional society wants more of its type of training in medical studies. At Texas A&M, we sponsor combined nursing and dietetics programs. Nurses are the frontline health workers who see every patient, especially in our disadvantaged communities. We need to educate these frontline workers about this nutrition education because these health care facilities just don’t have enough nutritionists to educate them about nutrition. “
Although the US has made progress in reducing hunger, “we now face this second crisis – one of food insecurity,” said Senator Cory Booker (DN.J.). (Courtesy photo of C-SPAN Livestream)
Food marketing and advertising are another piece of the puzzle, Booker said. “Most of our food system is now controlled by just a handful of large multinational corporations. These food companies format, formulate, and market low-nutrient, addictive, highly processed foods that now make up two-thirds of the calories. ”In the diets of children and adolescents in the United States Obesity and diabetes are somehow a moral failure in that they represent a lack of willpower or lack of exercise. It’s just a lie. “
Instead, Booker said, “It’s our collective political failure because the federal government is currently subsidizing easy access to high-calorie foods with minimal nutritional value, while too many communities – rural and urban – have no access to the healthy foods they thrive “Although federal guidelines suggest that American diets should consist primarily of fruits and vegetables,” less than 2% of our state farm subsidies in the United States currently go to these healthy foods.
Much of the marketing of unhealthy foods is aimed at communities of color, said Angela Odoms-Young, PhD, director of the Program for Food and Nutrition in Communities and Associate Professor of Nutrition at Cornell University in Ithaca, New York. A 2019 report by the University of Connecticut’s Rudd Center for Food Policy & Obesity found that “23 restaurants spent $ 99 million on television advertising aimed primarily at African Americans,” she said. “Compared to white preschoolers, black preschoolers saw about 72% more fast food ads.
“This has serious implications when you look at nutritional preferences in eating habits,” continued Odoms-Young. “Several studies have shown that immediately after seeing these ads, they crave unhealthy foods, junk food, and fast food. You can actually respond to this marketing. “
Booker said he and Braun passed legislation last week to convene a White House conference on food, nutrition, hunger and health, similar to the one convened just over 50 years ago. One witness who liked the idea was Donald Warne, MD, MPH, director of the Indians into Medicine program at the University of North Dakota at Grand Forks. “According to the CDC, 48% of Native American and Alaskan people over 18 are obese, compared with 30% of the non-Hispanic white population,” said Warne, adding that he was from the Pine Ridge Indian Reservation in South Dakota, which is the closest supermarket in Rapid City is 145 km away. “As a result, many of my family members face significant barriers to accessing healthy food, and many of them have diabetes and heart disease.”
In addition to the White House conference, “we also need a comprehensive political approach that is well coordinated and we need to understand the nuances in which tribes are engaging in these areas,” said Warne. “Ideally, we will involve stakeholders with lived experience in these important discussions.”