Still, the USDA, in giving advice, had to deal with, for example, saturated fats, which have consequences for health, but also for people who produce animal protein.
Yeah. USDA basically was in an unusual role of not wanting to say that there were any good foods or any bad foods; that all foods were okay, [presumably] eaten in some degree of moderation or discretion. So USDA was always very careful at not defining evil as part of any particular food category.
Part of that was the multiplicity of missions in the Department of Agriculture, because politically, the heart of the Department of Agriculture was food producers, was making sure that there were enough farmers alive and they could continue to produce food. So farmers produce all sorts of things, from fats to carbohydrates to proteins and everything in between. USDA has always had this little bit of conflicting mission between the producers of food and the consumers of food, and how to bridge that gap between the two of them hasn't been all that easy.
A food pyramid is a complicated political compromise?
It's complicated. Although I would have to say the government over the years, working within the agencies -- it's not just USDA; the food guide pyramid is also in partnership with the Department of Health and Human Services, although traditionally USDA has taken the lead in all of this -- has tried to kind of cut the baby in half, try to provide information without being terribly controversial on the food production side of the picture.
You get the sense that the stuff at the top, you're supposed to have less of; the stuff at the bottom, you're supposed to have more of.
That led to the notion that you should limit the amount of total fat. Therefore you have to eat something else, which would be carbohydrate. When you look back, do you think there were unintended consequences?
I think that based on what I know of the science at the time, the food guide pyramid was largely governed by nutritional information and science at the time, which was, carbohydrates were good and fats were bad. And quite frankly, the medical community was pretty much on line with that in the 1960s, 1970s and 1980s.
Science only fairly recently has begun to break down issues of carbohydrates and fats, particularly the fats, to show that some fats are good for you and some fats aren't good for you, and that carbohydrates are not necessarily good for you, and complex carbohydrates or whole grains are better for you than others are. A lot of that is fairly recent information in the science community. And USDA kind of lags [in] that period. It does not lead the science. It follows the science.
So against the changing nutritional science background, all this stuff plays out.
That's right. And again, the government was not going to take the lead in areas where the science was evolving or changing. In that sense, the government operates rather conservatively. …
The low-fat or no-fat dogma led people to think they could eat as much as they wanted of a low-fat product. Was that a surprise?
I guess it was a surprise, although when you look at the amount of sugar in a lot of low-fat diets, you began to see that medically this was an extremely misunderstood and complicated subject. But again, I think what we've got here is a kind of disconnect between the science, that was slow and evolving, the medical community, who frankly didn't show very much interest in this issue at all until recent years, and the government that was trying to provide reasonable information to consumers but always being pressured by the food production side of the picture.
During the 90s, there was awareness of an obesity epidemic, throughout this low-fat era. Also there was a huge diet business. What was USDA's role?
Well, actually, within the government, USDA led the effort in an outlining and opening up the door to understanding the significance of obesity, particularly childhood obesity. The fact was, during the last 20 and 30 and 40 years, even with the changes in our diet, we were rapidly growing a lot of very fat, very obese people, particularly among children, where the numbers were growing the most rapidly. So the government began to focus on it, and when I was at USDA, the Clinton administration asked me to take a look at this, along with Secretary Shalala at the Department of Health and Human Services. That's when the first studies were done.
USDA was providing an awful lot of food assistance to children, in the school lunch program and in the Women, Infant and Children Program, and what we also found is that among low-income people, they were not eating a lot of protein. They were eating a lot of carbohydrates. And they were the ones that were often finding the highest incidence of obesity, where the diet was not varied and when there was a huge amount of carbohydrates. So all these things together got us to begin thinking about maybe we should revise these guidelines we've put out.
They were following the USDA food pyramid and getting fat?
Yeah. I mean, my own belief is it was more than just the USDA food pyramid, because the USDA food pyramid was on almost every pediatrician's office door when you'd walk in. I mean, this was nothing that was not acceptable to the medical community as well. And of course the food industry followed the pyramid almost identically. And it turned out that the pyramid needs to be changed, and that's in the process of happening now.
You've got a conflict between your constituencies: farmers producing more food than we need, and the "American stomach," [that consumes] 1600 pounds of food per year.
Yeah, that's a lot of food.
How do you reconcile these competing interests?
Well, I tell you what. This is like the old H.L. Mencken quote: For every complicated problem, he said, there is a simple and a wrong solution. And in this case, you almost have this right now. I mean, we have a very productive agricultural sector here. And the American consumer, by and large, accepts on blind faith what their doctors tell them, what their food industry tells them, and there hasn't been historically a lot of independent analysis of the food production system in this country by the consumer. We of course have the nature of the American economy as such, that people are doing less exercise, more television watching. I mean, the whole thing is, it's a multi-faceted problem of obesity, and it's not just caused by the guidelines or the USDA.
The fundamental issue here, quite frankly, is that diet, nutrition, and obesity have not been viewed as a major public health issue in this country until fairly recently. Cigarette smoking was. AIDS has been. But overall, what people eat has been viewed to be surplus or extraneous to what the health problems are in this country, and so USDA was part of that. The food producers were part of it, but so was everybody. Nobody challenged the system.
What led up to the USDA's Great Nutrition Debate?
Well, I personally was interested in the subject for a lot of reasons. I had had some acquaintances, medical professionals and others, talk to me about diet when I came to USDA. And I began to see the amount of money that was being spent by people on finding answers to this problem of overweight and obesity, including myself, where I'm certainly not one that doesn't need to watch what I eat. I knew one of the people who was participating. I had met Dr. Dean Ornish before, who was a nationally known nutritionist. But Dr. Atkins was becoming quite famous and his books were beginning to sell.
What we [saw] at USDA and it struck us, is that there was an awful lot of rhetoric and books and magazines and information out there, and the American people were very confused about which road to go on. The roads were diametrically different. If you followed Dr. Ornish, you were going down one road, Dr. Atkins, a totally opposite road. And there was the Zone Diet, and now the South Beach Diet. A lot of different diets were out there. People were spending billions of dollars to try to lose weight, and there wasn't very reliable, credible information underlying the science of these things, at least in the minds of the people. So it struck me, we need to try to get some focus on this, to see if maybe the government can do some work to try to validate the good and bad points of these respective diets.
What kind of consensus did [you reach]?
There was not a lot of consensus at all.
You had them all in one room?
We had many of them in one room. And I recall that we had never had at USDA as much media attention, worldwide media attention, as we had that afternoon, that day. This was a subject that people are interested in. But there was not a lot of mutuality of interest. I think that one of the things that came through is there was a concern about excess sugar consumption, refined sugar consumption. Almost everybody agreed on that, that that was not good for you. But beyond that, it was no consensus. And I recall that Dr. Atkins and Dr. Ornish just about went at each other physically, and it was amusing to me, but I don't know if it was edifying to the people who buy books and try to find ways to lose weight.
Isn't it strange that the medical establishment wasn't comparing them head to head?
It's very strange, but it starts with the fact that nutrition is an under-taught course in most medical schools. Most medical schools, up until fairly recently, tend to teach doctors how to treat disease, and prevention is a very, very small part of their training. It was viewed as exotic if you were into disease prevention -- diet and exercise and all these other kinds of things. And I think that that is the main reason why there had never been very much medical research on diets, because it frankly wasn't a very big part of the teaching of physicians.
But now, as a public health issue, it's on the agenda?
What do you think can happen? This is an incredibly serious problem.
It's serious, but it's a complicated problem. And it relates a lot to extraneous issues, like diet and exercise, television, computer watching. [It] relates to the nature of fast foods, people's lifestyles. People aren't eating at home as much anymore. The kind of food that's eaten out tends to be higher in fat content than the kind of food that's eaten at home. The necessity to add fresh fruits and vegetables to our diet, starting at the school level. I mean, this is a multi-faceted problem that requires the schools to be very much involved, the food industry to be very much involved, and the medical community to be very much involved, and that is just beginning to happen now. It didn't happen for a very long time. …
Currently two-thirds or more of the population is overweight. Will this problem be solved? Will it take a long time?
I don't think you're going to overnight solve the problem, but I think that if it becomes a public health issue that is then implemented through solutions at the medical levels, at the schools, if it becomes a part of our culture to deal with, like for example cigarette smoking has, or AIDS has, then I think we'll make real headway on it.
But it's going to be slow?
It'll be slow, and it probably will do like most issues in our society have. Higher-income levels will probably deal with this issue at much faster rate than the lower- and middle-income levels will. To some extent this is a class issue too.
To what extent is the national crisis in obesity rooted among poor Americans?
It's a bigger problem among lower-income Americans. Part of it is because I think their diet is not as diverse. There are studies that show that there is higher starch consumption and less fresh fruits and vegetables, for example. But it's not a problem that's just focused on lower income people. It's a problem that's really inter-class, although it does tend to be a bigger problem as you go down the income ladder. …
Are we, America, exporting obesity as a problem? I mean, McDonald's all around the world. Suddenly people in Japan [are] getting heavier.
My judgment is that what is being exported is modern technology and modern lifestyles. The focus on the computer, on television, the changing cultures in the world where more and more people are not eating at home, and the focus on fast foods, it's all part of a bigger picture and a change in lifestyle. Whether we're exporting it or not, or whether the rest of the world is just catching up with it, I'm not particularly sure. I don't think it's particularly useful to focus, let's say, on McDonald's or on a particular American product, because I think the real problem is the food consumption, lack of exercise, nature of society, and change in the family structure that we've got.
[What about] portion sizes?
I think there's a lot of problems with the food consumption. For example, food is very cheap in America. We pay less per capita of income on food than any other country in the world. So we do tend to jump up portion sizes because quite frankly, it's not expensive at all. And so I think yes, that is certainly part of the problem. You can see that in terms of snack foods, the amount in a particular serving. You can see it in terms of restaurant consumption generally, and fast food particularly.
It's sort of this endless mall of temptation when you go shopping in America. You pass by dozens of fast food chains, everything -- donuts, hamburgers, all bigger sizes. It's kind of overwhelming.
But it's all based upon our lifestyle. The fact is that the economics of the world make it a lot more difficult for, let's say, one parent to be at home, for cooking to take place at home. We eat out much more than we ever used to before. Food is cheap. Fast food is very inexpensive. And so from a public health perspective, I don't think you can deal with this problem just pointing to one aspect and saying it's the problem of fast food. I think you have to look at the whole picture to make a change. And the place to start is in the schools, because that is where eating patterns develop early in life.
Now, isn't it true that in the last decade or so especially, that school lunch programs, which were monitored by the USDA, schools and the government seem to have lost control of those? I mean, I walk into a high school now, and there's Pizza Hut, or there an incredible array of Coke machines, selling oversized Cokes.
Let's take a look at the base issue here. Part of the issue actually has gotten better. That is, USDA has required that [if] schools participate in a school lunch program, that they reduce their fat consumption. And it has, in fact, come down to some degree. The USDA and others are trying to get more fresh fruits and vegetables into the school lunch program, and Congress has been working on this particular issue. Now, that's one side of the picture.
The other side of the picture is that schools are under-funded today. They're strapped for money. So schools look for ways to raise capital wherever they can, to fund particularly athletic programs, extracurricular activities. And in doing so, they'll go into the outside world, whether it's soft drink companies or snack food companies, in order to sell a product which produces revenue for the schools. So in a sense, you kind of have conflicting--
-- messages there. But part of it is based upon the fact that the economics of education, particularly of public education, are pretty bleak right now.
We were talking about the food pyramid before. Walter Willett, also at Harvard, [designed his own food pyramid, the base of which] is exercise. Do you think that's a good idea?
I do. And I think that that is something that's non-controversial too. My judgment is that the next pyramid -- which will come out [in the] year 2005, I think -- will include exercise as a big part of it.
How about his next level up, which are oils? That used to be up at the very top. "Don't mess with oils. They're fattening." Suddenly olive oils, canola oil, others, he says it's very good for you.
I think he's correct on that as well. I'm not a scientist, and I can't tell you exactly which oils are good and which aren't, but I think he makes a good case that we need to go to the next level of sophistication and break the oils down, so that the olive oils, the mono-unsaturated oils are in a better position than, let's say, the saturated fats and the trans fats, which are in a very bad position. And I think that will also happen in the next segment of the food guide pyramid.
Let me ask you about federal policy. When you were part of the Clinton administration, Clinton's surgeon general declared, "Look. Obesity, this is a national crisis." That was a new thing, right?
It was. Clearly, the late '90s was the first time the government really came out focused on obesity, and that's been carried forward by the current Secretary of Health and Human Services, Tommy Thompson.
So Thompson is taking it seriously?
Yes. I think that he is. I think that he's taken this health perspective of his job very seriously.
What about the Bush administration?
Well, I think their natural constituencies are with the business community, and part of that is the food community. I think the Bush administration is probably going to be institutionally reluctant to take on the food industry in terms of some of these issues, for example increased regulations on the sale of food, and increased labeling, and the restaurants or the food industry, those kind of things.
But on the other hand, this is such a big public health issue, relating to costs, whether it's type 2 diabetes or heart disease or cancer, and the effect on kids particularly, that I suspect there is going to be more and more consumer interest, and the Bush administration will not be able to fight this in a rear-guard action.
I mean, it's interesting when you look at Bush himself. Here's a guy, I guess he's having some trouble with his knees now, but he seems pretty obsessed with exercising and his own weight.
Yes. And I don't know what the president's own diet is, but my presumption is, it's pretty good, because he looks very--
Probably not too many pork rinds.
Yeah. He looks pretty healthy, and what would be great is to see the president himself get out in front on this issue. It's tricky because a lot of the economic interests in production agriculture, frankly, probably are not terribly interested in the government getting too actively out in front on these issues, because it will mean some changes in their marketing, or costs on labeling or other kinds of things. But there's probably nothing that we could do more to reduce the cost of medical care in this country over the long term than to tackle some of these issues dealing with diet and nutrition and the related obesity issues.
Because if type 2 diabetes really becomes an epidemic linked to this obesity crisis, [we're] talking about incredible medical costs for a baby boomer generation.
That's right. High costs there, as well as heart disease and other kinds of things. You know, Ben Franklin said you are what you eat. Growing up in a family where my mother used to force-feed food down me all the time and everything else, to some extent it's true. Food and eating is such an enormous part of our culture in this country. Just think about it. Almost everything we do is around eating, from just breakfast, lunch and dinner, to celebrations, to funerals, to weddings, to everything in the world. Everything is related to food.
That's why the issue is so complicated deal with, why it's so hard to pin your finger on a culprit here. Frankly, as Pogo said, "We have met the enemy and he is us." We are all part of this particular problem, and we're going to have to all be part of the solution. So yeah, food industry's partly responsible. The government could be doing a lot better as well. The schools could be doing better. The medical community is probably the one I would pin most of the blame on over the years, but ultimately there is some personal responsibility here too. …
We're in an era when people want, they say, a lot less government, a lot less regulation, and yet here's this huge national problem that people have not paid attention to. And you're saying the government has to do something; schools have to do something.
Yes, and that means they need resources. And that's not just the federal level. It's the state level and the local level. School districts need to give as much attention to what kind of food and how it's served in the schools, as they do on other kinds of curricular programs. But this has got to be kind of a national effort.
I go back to the cigarette issue. The diet issue is not the same as the cigarette issue, because again, in cigarettes you were dealing with a product that was inherently dangerous. So there was no argument, at least not in recent years. Food is more complicated. Some foods are higher in nutrition, some are lower in nutrition. Most foods, if eaten in some degree of moderation and you have good exercise, you can probably get away with eating some fancy, sugary, fat desserts periodically and not killing yourself, [that] type of thing. So the science is a lot less specific and precise as it certainly was with cigarettes. …
We don't have a simple solution. ... Just let me ask you point blank. What's the most important thing that the government could do to deal with a crisis in obesity?
Research, to make sure that we know what [in] fact you need to consume or you don't need to consume, so that the public is not inundated by inconsistent information. That means that we've got to research diets and got to do a lot more work on specific foods. That's a big part of it. Second part of it is that in the government programs in the schools and the other food assistance programs, they need to be made consistent with modern science, and we need to do a lot more educating in the schools as to what is good for you and what is productive in terms of diet. Third is exercise, which has to be a part of certainly American society.
And fourth, the medical community must become actively engaged in this issue like they are engaged with catastrophic disease. When you go to a doctor and you're very sick, we can really treat people very well. But prevention has never been, at heart and soul, part of the American medical system, at least with respect to the providers of healthcare.
The system has never considered it very exciting.
It's not exciting, and it doesn't produce overnight results and miracle cures and that kind of thing. They're all parts of this thing. The media has a big role to play in this as well. Media's doing a better job now than they've done before. They're talking about these issues now, but the media has such a big, powerful role to play in creating people's attitudes, that frankly, I think the future is a lot brighter in this area than it's been in the past.