New Sanford dean takes stock of nutrition, obesity, and health policy
A conversation with Jacob Dagger, Duke Magazine
This summer, Kelly Brownell was named dean of the Sanford School of Public Policy after serving eight years as founding director of Yale University’s Rudd Center for Food Policy & Obesity. One of the world’s foremost experts on the obesity epidemic, Brownell has long advocated harnessing the powerful research going on at places like Duke and Yale to drive changes in public policy.
Your academic background is in clinical psychology. How did you get interested in studying obesity, nutrition, and public policy?
I’ve really gone far afield from my roots in clinical psychology. I cut my academic teeth doing randomized trials for treating obesity. The results were frustrating. That led me to think about prevention, and you naturally think about public policy and changing the drivers out there in the environment that might be causing the problem in the first place.
What are the root causes of the obesity epidemic?
Bad environment. Some people say biology is a player. That’s true to a certain extent, because it might determine which individuals in a particular environment are most susceptible to the problem, or will develop it to the greatest extreme. But it’s clearly the environment that’s driving the problem. Obesity is increasing in every country in the world. You certainly can’t blame that on changing biology, and it’s pretty hard to say that the entire world is becoming personally irresponsible.
The worsening environment has a number of components. Large portion sizes, the very aggressive marketing of the least healthy foods, pricing incentives to buy large amounts of things, changing food norms about what times of day to eat are all part of a very systematic effort to encourage maximum consumption of unhealthy food.
Can you give an example of these changing norms?
About three decades ago, one of the fast-food companies announced they were going to sell fast food for breakfast. People thought they were going to go out of business because Americans would be insulted at even the thought of eating fast food for breakfast. And look at how routine that has become. Now the fast-food companies are trying to teach people that it’s okay to eat fast food after midnight.
You have written about other changes, like price incentives that encourage us to eat unhealthily. Can you talk a little bit about those?
If you go to a fast-food restaurant, you can get a package meal, where if you buy the burger and the fries and the drink together, you pay less than if you bought them separately. Now if you go to the supermarket, and you buy cauliflower and lettuce and carrots, you don’t get a bargain just because you’re buying three things at once.
There are other ways of thinking about this. For example, the government subsidies to the farmers put in place during the Nixon administration were initially conceptualized as a means of helping the farmers compete in the world market. But the heavy subsidies to corn and soybean farmers, for example, have made it possible to create lots of processed foods at very low costs. So if you drive up to the fast-food window, and you buy that packaged meal, the government is helping you buy that hamburger, because the grain that feeds the cow is subsidized. It’s helping you buy the French fries because of the subsidies for the oil used to fry them, and it’s helping you buy the soda because of the high fructose corn syrup. But if you buy a bottle of water and a salad, the government doesn’t help at all. The incentives are lined up in the wrong way.
Government is now beginning to question the role it plays in this, and finally agriculture and nutrition policy are beginning to line up with health policy. So as an example, there are big food entitlement programs in this country, like food stamps. And the nutrition standards changed. There’s a long way to go, but you see signs of change, which I believe are very positive.
How do you think these new policies will stand up to lobbying from large industries that have benefited from subsidies for decades?
You could say that these companies are so powerful and that there’s just no hope of getting through the lobbying muscle that they exert. It’s not just the obvious ones like Coca-Cola and McDonald’s and Kraft, but it’s a series of agribusiness companies that are extremely powerful as well, like Cargill, ADM, Monsanto, and the like. Now you could say that these companies are so powerful that there’s no hope, but then you can look at tobacco as the example where at one point people thought there was no hope of taking on the tobacco industry because it was so powerful, but from a public health point of view, this has been a big success.
As you look at potential solutions, and at tobacco as a model, are there major differences between junk food and obesity and cigarettes and cancer?
With tobacco, there was essentially one product and about six companies that sold it. With food there are tens of thousands of products, and tens of thousands of companies that sell them.
Another obvious difference is that you don’t have to smoke to live, but you do have to eat. So the goal isn’t for the food companies to go out of business. The question is, can you work collaboratively with the industry to change the portfolio of products they sell, to change what they’re marketing, especially to children, and to create price incentives that lead people to eat healthier?
The problem is that the food industry has created this business model where they’ve tried to maximize the palatability of food, so they’ve pushed up the sugar, fat, and salt.
What’s your take on Michael Moss’ book, Sugar Salt Fat, about the food companies’ very rigorous scientific push to maximize palatability and consumption, with little regard for health?
What we believe happens is that the body doesn’t know how to deal with these highly processed foods. Human physiology, the brain, this cascade of things that happen when you eat food— they evolved to handle things that are found in nature. Once you process these things and they become unrecognizable to the body, you’ve got a real problem.
You could take the coco leaf, in nature, and people can live in harmony with it if they chew it or do something that’s mildly reinforcing. But when you process it and it becomes cocaine, or you hyper-process it and it becomes crack cocaine, then people no longer can live in harmony with it. So how different is that from corn? I’ve never known anybody who abuses corn. But you turn it into Cheetos, and then people have trouble shutting off.
Earlier, you mentioned the issue of agricultural subsidies, of processed corn and soy potentially causing problems. Could we simply end those subsidies?
Those subsidies are a real political hot potato, because the entire agriculture industry has shifted itself to take advantage of them. So the legislators who represent these agricultural areas are very reluctant to take on the subsidy issue. But there’s more and more pressure to do so, and I expect that at some point it will happen.
But there are a number of things you need to do, so just changing the subsidies is probably not going to affect the obesity problem. Just taxing soda will probably not have a big impact. Just limiting portion sizes? Same thing. You need to do a lot of these things at the same time.
Some of these issues have very interesting global implications. For example, some people believe that one of the most pernicious influences is the marketing of unhealthy food to kids. There’s an enormous amount of it, even though the industry is pledging to do better.
There are some places in the world that have tried to take this on. The province of Quebec, for example, many years ago produced legislation that basically forbade the advertising of any product to children. Not just food products, but any product, with the belief being that kids weren’t developmentally advanced enough to realize they were being marketed to. Some of the Scandinavian countries have passed legislation forbidding the marketing of unhealthy food to kids. So this is fine, until the geographic area that has passed the legislation no longer controls the media that come into it. In the old days, when you had a television station, and the content could be modified, that was fine. But what about the Internet? What about satellite television? These are sources of information that aren’t even originating in the places where the laws have been passed.
The subsidies are a global issue, because if a country like the United States—and this happened of course— does a heavy subsidy of corn, all of a sudden the production of corn in the U.S. goes through the roof. We flood the world market with low-cost corn. Indigenous farmers in places like Mexico and India can’t compete with this. They tend to go bankrupt, move to the cities, and become the urban poor. So you have these ripple effects throughout the world. It’s important to understand what they are, so you can make sensible world food policy, and not just tweak one thing in one country.