RFK Jr. Wants to Change What Americans Eat. He’s Not The First.

Dan Gorenstein: This week, Robert F. Kennedy Jr. narrowly secured the endorsement of a Senate committee to become the country’s next Secretary for Health and Human Services. Now, the full Senate must decide if he gets the job or not.

Kennedy has alienated many senators with his views on vaccines. But he has won wide support for his calls to fight some chronic diseases by going after America’s abundance of processed foods and sugary drinks.

The foods have been linked to the nation’s rising rates of diabetes and  obesity, with an estimated 15 million American kids considered overweight or obese as of 2021.

Robert F. Kennedy Jr.: Something is poisoning the American people. And we know that the primary culprits are our changing food supply. The switch to highly chemical-intensive processed foods. 

DG: Kennedy, who could be confirmed in days, would then be positioned to escalate the long-running battle to drive down sales of unhealthy snacks, drinks and meals.

But we’ve learned – effective policies – can take years to get off the ground.

And we’ve learned – the food industry – can be effective at burying those policies.

Today … the tough-to-swallow history of the soda tax … and whether Kennedy’s ideas could wind up in our shopping carts and on our dinner tables.

From the studio at the Leonard Davis Institute at the University of Pennsylvania, I’m Dan Gorenstein, this is Tradeoffs.

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DG: Laura Schmidt began her career studying alcohol and drug use. She was particularly interested in what was driving higher rates of addiction in lower-income communities.

In 2005, as a health policy researcher at the University of California, San Francisco, she was struck when working in the city’s Tenderloin neighborhood.

Laura Schmidt: I kind of had an ah-ha moment where I realized, wow, at least we have regulations in place to protect the kids in this community from tobacco and alcohol. But when it comes to ultra-processed foods, we’ve got nothing. We have no taxes. We have no warning labels. And that was when I regeared myself and started thinking about ways to apply what we already know from the tobacco and alcohol fields to the ultra-processed food situation.

DG: Laura has devoted her 40-year career to researching how to prevent chronic conditions.

And in the last two decades, she’s come to see how dangerous the ultra-processed foods that we eat are.

LS: So it’s no wonder that we’re seeing childhood diabetes, childhood fatty liver disease, childhood obesity — because our food system is saturated with unhealthy products.

DG: So I know you know this, Laura, but like the research for processed foods is that this stuff is everywhere. I mean, an estimated 73% of the U.S. food supply falls into this category of ultra-processed foods. But your work also focuses on what processed food does to our brains. Right? What does the research there show?

LS: For years, I was pretty convinced that alcohol, tobacco, substances of abuse were a pretty narrow category, and was skeptical of the idea that ultra-processed foods could be addictive. That said we have evidence from inside the industry — in the words of industry executives themselves, through industry documents, research. We know that many of the ultra-processed foods on the market today were engineered to be addictive. We have clinical studies showing that people with binge-eating disorder, people with bulimia are obsessed with carbohydrate-rich foods and foods with sugar, fat and salt in unnatural amounts.

DG: And this is a category called hyper-palatable, right? 

LS: Yeah, that’s science code for addictive. Hyper-palatable is a definition that’s currently being used in the scientific community to describe what’s different about these ultra-processed foods. And they leverage our instinctual drive towards sugar, fat and salt, towards high-calorie, calorie-dense foods, with the goal of getting us to eat more.

DG: With the awareness that these foods — with their high levels of sugar, fat, and salt — were so addictive, policymakers, right, began to try to steer people away from these unhealthy products by taxing them.

Laura, you were involved in the 2014 campaign to tax sugary drinks, both in San Francisco and ultimately the larger Bay Area, including Berkeley. The hope was that this tax would, like, nudge citizens to drink less. In that moment, was there any reason, was there any data to go off, that this was going to work?

LS: The only data available was data from alcohol and tobacco taxation. But there we have pretty much every country in the world has an alcohol tax. The reason they tax is because it works. It lowers consumption. And there’s a whole science in how to tax. You can tax spirits more than you tax beer and wine and on and on and on. And so that was the science that lawmakers were going on back in 2014 when Berkeley passed the first soda tax in America.

DG: And what happened?

LS: So I think initially, um, in Berkeley, a lot of the taxation movement came out of the schools and worried parents, and I think their thinking was, OK, if nothing else, we’re going to tax this unhealthy product. Maybe it’ll lower consumption, maybe not. But what it will do is it will generate funding for the schools. As it turned out, the effect of the tax at the cash register was significant, and it actually decreased sales of soda and promoted sales of bottled water and other healthier products. So Berkeley voters wound up getting both benefits.

DG: They got money and they got public health benefit. And so I’m, I’m curious, Laura, when this passed, just as a researcher in this space, were you kind of, like over the moon? I mean, what was your reaction to this?

LS: I was pretty darn excited.

DG: Why?

LS: It’s incredibly rewarding. When your head hits the pillow at night, you feel like, okay, you know, we made a dent in a really big problem. These kids growing up in these communities are going to live with the health harms of having inadequate access to food for the rest of their lives. And the great thing about the taxes is, because they generate funding, that means you have a dedicated funding stream to pay for programs and pay for healthy food in the schools or whatever it is the community needs.

DG: And so the tax has been in effect for a decade now. What do we know about whether it changed anything on the ground in Berkeley? Do people drink less soda? Are they healthier?

LS: Yes. To both questions. They’re drinking less soda. We know that we’re preventing new cases of childhood obesity. We know that we’re reducing rates of gestational diabetes in Black moms. And this is all coming out of rigorous studies that use control groups and leverage hospital data collected through the electronic medical record.

DG: Did this tax kind of, like, hit it out of the ballpark for what people were aiming for?

LS: I think so. I mean, I think the way that you can measure that is that over 80% of voters in Berkeley said, we don’t just want a temporary tax. We want this to be made permanent. It was a robust ballot initiative just in November.

DG: And so, you know, other cities followed Berkeley’s lead: San Francisco; Oakland; Boulder, Colorado; Philadelphia. Can you describe that moment? As more and more cities across the U.S. are beginning to embrace this idea. 

LS: It was pretty exciting. And I think it had a quality of a sort of virtuous cycle. Because taxation is unique when it comes to public health strategies, because it generates funds. And if governments do the right thing with those funds and they direct them toward public health purposes, they are doubling the impact of the tax.

DG: And were you, at this time, you know, 2014, 2016, 2017, were you thinking: “This is going to change the trajectory of diabetes, obesity.” Did you allow yourself to hope?

LS: What I thought was this is the first step. Because if you start with taxation, you generate funds. When you use those funds to promote public health, then you have all this ability to do other things. You can research better ways to promote health. You can create warning labels. With public health policy, it’s never one lever. Especially with a problem as big as this one, you really need multiple public health levers.

DG: And did you see taxes taking hold widely?

LS: Well, I, if you want to get to the sad part of the story, we can now talk about what happened which was, from my experience, a pretty big shock. So we got the Bay Area taxes passed starting in 2014. By 2016, we had many, many cities in California that were poised to pass a tax. And then what happened is the American Beverage Association, its lobbyists, uh, went to the governor, and what they said was, we’ve got enough votes to put on the California ballot, an initiative that no city can pass any tax. So your fire department, your libraries cannot, you can’t raise taxes to support them. And we’re going to put it on the California ballot, if you don’t cut a deal with us. And that deal is no new soda taxes for the next 12 years. 

DG: And to be clear, the ballot initiative in California would have permitted new local taxes, but would have made them much harder to pass, requiring a two-thirds majority to be adopted. Lawmakers ultimately made that deal.

LS: Yeah. There was literally an Assembly member in the California State Assembly who said, “I am signing this legislation with a gun to my head,” because it was impossible to imagine allowing a ballot initiative to go out there.  This is called preemption. And so this was essentially the end to the soda tax movement in California. It went into effect in 2018, and since then we’ve had no new taxes. 

DG: And so seeing these laws passed in Arizona, California, Michigan and Washington, it has had a chilling effect. The momentum that we felt a decade ago, the enthusiasm of trying to get ahead of this has all but stopped.

LS: All but stopped. And so, while there was a chilling effect within the U.S., internationally, it almost read the opposite. It said, OK, the U.S. isn’t going to regulate these companies. We better do it ourselves. We better protect ourselves. And we’re also seeing that happening with other forms of public health legislation like warning labels. We now see a robust movement internationally to pass warning labels. Here in the U.S., the industry has, and lobbyists have prevented us from doing what would make sense to put a warning label on the front of the package that’s really meaningful and alerts consumers to what’s healthy and what’s not healthy. But everywhere else in the world, this is a real movement.

DG: Laura, thanks so much for taking the time to talk to us on Tradeoffs.

DG: When we come back, Tradeoffs producer Melanie Evans on the ways that RFK Jr., if confirmed, could use policy to shift American diets and whether it helps that he’d be part of a Republican administration. 

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That’s tradeoffs.org. Back in a minute.

MIDROLL 

DG: Welcome back. 

Robert F. Kennedy Jr. may soon be the nation’s next health secretary. He has promised to go after processed foods and sweet drinks as part of his campaign to Make America Healthy Again. 

Before the break, we heard about how lots of people have been working toward the same goal for years, with very mixed success. 

We asked Tradeoffs producer Melanie Evans to look at what Kennedy, as HHS secretary, could do to make what we eat more healthy 

Hi Melanie 

Melanie Evans: Hi Dan.

DG: So, let’s start with what Kennedy has said he would like to do. He wants to get unhealthy food out of school lunches and the food stamp program, now known as SNAP. But he really can’t do much here, right? 

ME: You’re right Dan, in one very important way. The Department of Agriculture runs the programs that bring lunches to schools and helps people buy food. HHS is on the sidelines. 

But when we look at what authority the agency does have over food, Kennedy still could do a few major things. 

DG: OK. Where do we start? 

ME: Let’s begin with guidelines, which seems a little squishy, I know. The nation has dietary guidelines and they get updated every five years. The next update is expected later this year. 

DG: How much can dietary guidelines actually change things? 

ME: Well, one former Food and Drug Administration official explained it to me this way: These guidelines are a roadmap for policy. They become the reference point for some pretty influential decisions. 

Susan Mayne So if the dietary guidelines, for example, say, as they have for many years, that we eat way too much sodium, way too much added sugars and way too much saturated fat, then the agencies will say, well, what can we do about that? 

ME: That’s Susan Mayne. She teaches at Yale.

Susan ran the FDA’s food safety center under the Obama, Trump and Biden administrations.

She gave me a great example of how the FDA leveraged these guidelines. 

Now, Dan, have you actually looked at the nutrition fact-label on food packages? 

DG: I mean, of course! (laughs)

ME: OK, excellent, you’re doing better than I am. I’m pretty hit or miss. (both laugh).

Food companies had to update those labels with information on added sugar. So, this is the extra sugar that companies put into foods that ends up increasing your calories, but without any real nutritional benefit. 

Susan worked on that update. 

And she says the reason we’ve got those new labels is because the dietary guidelines called for Americans to cut back on added sugar.

Kennedy — as secretary — would have influence on these guidelines, which are jointly developed by HHS and the Agriculture Department.

And, as Susan points out, the FDA also has authority to turn these guidelines into requirements for the food industry. The most obvious way that happens is when the FDA uses the guidelines to inform nutrition labels we see on packages. 

Christina Roberto: There are very few things we do that actually hold industry accountable to transparency in our food supply. And food labeling is just a very straightforward way of giving consumers that information that I think they deserve and have the right to know. 

ME: This is Christina Roberto at the University of Pennsylvania at the Perelman School of Medicine.

Dan, there’s more to labeling than what’s on the back of the package. For example, the FDA recently updated the criteria food companies must meet in order to describe their products as healthy. 

The agency also just released a proposed rule to put key nutrition information on the front of food packages. Kennedy would be the one to finalize rules on this new labeling. 

DG: Wait, I’m pretty sure I already see information on the front of many food packages.  

ME: You are correct, Dan. I have here a package of Oreo Double Stuf cookies. 

DG: I love Double Stuf. 

ME: They are so good. In the lower left corner of this very distinctive blue package there are these … 

DG: I thought it was a pink package. It’s blue? 

ME: It’s blue. It’s blue. It’s got a little pink on it. But it is blue. So we’ve got these three little boxes with a few numbers for calories, the number of grams of saturated fats and added sugars, the number of milligrams of sodium. 

DG: All things to look out for if you want to eat healthy. Like I do. I’m super fit over here, Melanie Evans. I just want you to know. 

ME: Well, I’m the one holding the package of Oreos. Tells you everything you need to know. So the FDA wants the package to tell consumers whether food is low, medium or high in these key nutritional categories. Forget trying to make sense of the numbers. I’m looking at these Oreos. Is 13 grams of added sugar a lot? 

DG: I’m going to guess yes – I mean, it sounds crazy. So these are proposed changes. The next HHS secretary — Kennedy, if he’s confirmed — could make them final? 

ME: Correct, right now, the public — including the food industry — can comment on the proposed rules. 

So, Christina said the industry also responds to labels. Manufacturers will make changes in ways that can be helpful, such as lowering sodium, or sneaky, which is when they kind of swap ingredients to game the labels without delivering much healthier food.

That’s why she said she’s glad for this recent increased focus on ultra-processed foods. 

CR: And it’s really trying to message to the consumer that there’s a lot going on with this Oreo. Not only is it high in sugar, saturated fat, you know, and these harmful ingredients, but now we’re also talking about additives. We’re also talking about the marketing, right? We have these such strong, positive associations with these ultra-processed junk foods. We’ve been marketed forever, right? We have our best childhood memories tied up in them. And so what it’s capturing is not just this single food product, but like the whole addictive experience — the color, the packaging, the feel, the memories, the deliciousness — all of it. And I think that’s what’s very useful about this idea of ultra-processed junk food.

DG: Ok. So far, Melanie, it sounds like HHS has some power to shape nutrition information that policymakers and consumers use to make choices. But Kennedy has talked about going after what goes into our foods. What kind of leverage, if any, would he have there?  

ME: The FDA does regulate food ingredients and has used that power before to remove things that science identifies as dangerous. So, this happened with partially hydrogenated oils back in 2015, when the FDA said it was a dangerous source of trans fats. So, trans fats increase the bad cholesterol that’s linked to heart disease. Regulators gave manufacturers a few years to take it out of their products. 

DG: That seems like a potentially very powerful way to regulate America’s food supply. Kennedy’s been very vocal about additives. Could he make real headway here?

ME: Yes, Dan, but researchers and former federal officials I spoke to said this process is slow and uncertain. 

Decisions about the safety of ingredients require, first, research to understand the potential harms. Then they go through proposed changes. There’s drafting of rules, there’s seeking comment, there’s revision of regulations — all of which could ultimately be challenged in court.

Susan Mayne, who was at the FDA, told me there’s also the potential for political pressure on the agencies from Congress.  

SM: For some of the nutrition initiatives we were trying to move forward during the Obama administration, there was strong resistance by certain members of Congress. And the food industry doesn’t really like regulation as a general matter.  So they can turn to members of Congress and use the leverage that they hold with members of Congress to make it challenging to move forward with regulations.

DG: Melanie, this example from Susan and the conversation I had with Laura Schmidt about the soda tax get at the food industry’s, sort of, raw power here.

Clearly they are willing to wield it and that’s going to continue to be the case, of course, if Kennedy becomes Secretary.

The question in my mind is whether Kennedy is better positioned than previous Secretaries to do more to make our food healthier, because he’s again, not like the first secretary who’s been concerned about these issues.

ME: Right. Well, Susan does see one path to making progress.  

She told me she faced the most pushback on FDA food policies from one of the political parties.  

SM: And I would say the majority of the resistance came from Republican members of Congress, which is not surprising given the regulatory agenda versus a deregulatory agenda. 

ME: That agenda remains alive in the new administration. 

So that means if Kennedy and President Trump really want this they will have to make a compromise with themselves.

SM: We have a really unique opportunity to get bipartisan support for a healthier food supply, which is not what I experienced during previous administrations. So that’s an opportunity. But what it means is that they would really have to prioritize health and nutrition over deregulation. That’s a really important thing. So which is going to win that battle in this administration is a really important question.

DG: If Kennedy is confirmed, perhaps, Melanie, we will find out. 

Thank you very much for your reporting on this. 

ME: You’re welcome. 

DG: I’m Dan Gorenstein. This is Tradeoffs.