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Republicans are the party of Big Energy and Big Food: they dominate contributions from extractive industries and agribusiness. And they are, in particular, the party of Big Pizza.

pizza partisanship tells you a lot about what is happening to American politics as a whole.

Why should pizza, of all things, be a divisive issue

The immediate answer is that it has been caught up in the nutrition wars

the pizza sector has chosen instead to take a stand for the right to add extra cheese.

The rhetoric of this fight is familiar. The pizza lobby portrays itself as the defender of personal choice and personal responsibility. It’s up to the consumer, so the argument goes, to decide what he or she wants to eat, and we don’t need a nanny state telling us what to do.

it doesn’t hold up too well once you look at what’s actually at stake in the pizza disputes.

what do contributions in the last election cycle say? The Democrats are, not too surprisingly, the party of Big Labor (or what’s left of it) and Big Law: unions and lawyers are the most pro-Democratic major interest groups.

Nutrition, where increased choice can be a bad thing, because it all too often leads to bad choices despite the best of intentions, is one of those areas — like smoking — where there’s a lot to be said for a nanny state.

diet isn’t purely a personal choice, either; obesity imposes large costs on the economy as a whole.

But you shouldn’t expect such arguments to gain much traction

For one thing, free-market fundamentalists don’t want to hear about qualifications to their doctrine

Also, with big corporations involved, the Upton Sinclair principle applies: It’s difficult to get a man to understand something when his salary depends on his not understanding it

nutritional partisanship taps into deeper cultural issues.

At one level, there is a clear correlation between lifestyles and partisan orientation: heavier states tend to vote Republican, and the G.O.P. lean is especially pronounced in what the Centers for Disease Control and Prevention call the “diabetes belt” of counties, mostly in the South, that suffer most from that particular health problem

At a still deeper level, health experts may say that we need to change how we eat, pointing to scientific evidence, but the Republican base doesn’t much like experts, science, or evidence. Debates about nutrition policy bring out a kind of venomous anger — much of it now directed at Michelle Obama, who has been championing school lunch reforms — that is all too familiar if you’ve been following the debate over climate change.

It is, instead, a case study in the toxic mix of big money, blind ideology, and popular prejudices that is making America ever less governable.

the Harvard School of Public Health published a paper that used the height of women in 54 low- and middle-income countries to indicate how children in Africa, Latin America, Asia and the Middle East were faring. (The answer was not good: height had stayed the same or declined, particularly in Africa, suggesting that living conditions and disease controls for children have deteriorated.)

If food production is the most important factor, then focusing on economic growth might be the best policy, but if infectious disease is a major reason for chronic illness and premature death, then more aggressive public health measures might also be needed.

historians have not paid enough attention to changes in height (as a useful measure of nutrition and disease) or in lifespan. History textbooks, she complained, almost completely ignore the topic.

Dr. Monteiro and his colleagues developed a food classification system called Nova, named after the Portuguese and Latin words for “new.” It has since been adopted by researchers across the world.

Unprocessed or minimally processed foods, like fresh or frozen fruits and vegetables, beans, lentils, meat, poultry, fish, eggs, milk, plain yogurt, rice, pasta, corn meal, flour, coffee, tea and herbs and spices.

Processed culinary ingredients, such as cooking oils, butter, sugar, honey, vinegar and salt.

If you look at the ingredient list and you see things that you wouldn’t use in home cooking, then that’s probably an ultraprocessed food,”

his group includes freshly baked bread, most cheeses and canned vegetables, beans and fish. These foods may contain preservatives that extend shelf life.

Ultraprocessed foods made using industrial methods and ingredients you wouldn’t typically find in grocery stores — like high-fructose corn syrup, hydrogenated oils and concentrated proteins like soy isolate.

They often contain additives like flavorings, colorings or emulsifiers to make them appear more attractive and palatable.

Think sodas and energy drinks, chips, candies, flavored yogurts, margarine, chicken nuggets, hot dogs, sausages, lunch meats, boxed macaroni and cheese, infant formulas and most packaged breads, plant milks, meat substitutes and breakfast cereals.

Processed foods made by combining foods from Category 1 with the ingredients of Category 2 and preserving or modifying them with relatively simple methods like canning, bottling, fermentation and baking

Most research linking UPFs to poor health is based on observational studies, in which researchers ask people about their diets and then track their health over many years.

That has led to debate among nutrition experts about whether it’s useful for describing the healthfulness of a food, partly since many UPFs — like whole grain breads, flavored yogurts and infant formulas — can provide valuable nutrients

Why might UPFs be harmful?

In a large review of studies that was published in 2024, scientists reported that consuming UPFs was associated with 32 health problems, with the most convincing evidence for heart disease-related deaths, Type 2 diabetes and common mental health issues like anxiety and depression.

Such studies are valuable, because they can look at large groups of people — the 2024 review included results from nearly 10 million — over the many years it can take for chronic health conditions to develop

She added that the consistency of the link between UPFs and health issues increased her confidence that there was a real problem with the foods.

But the observational studies also have limitations,

It’s true that there is a correlation between these foods and chronic diseases, she said, but that doesn’t mean that UPFs directly cause poor health.

Dr. O’Connor questioned whether it’s helpful to group such “starkly different” foods — like Twinkies and breakfast cereals — into one category. Certain types of ultraprocessed foods, like sodas and processed meats, are more clearly harmful than others

UPFs like flavored yogurts and whole grain breads, on the other hand, have been associated with a reduced risk of developing Type 2 diabetes.

The Nova system notably doesn’t classify foods based on nutrients like fat, fiber, vitamins or minerals. It’s “agnostic to nutrition,”

In that study, published in 2019, 20 adults with a range of body sizes lived in a research hospital at the National Institutes of Health for four weeks. For two weeks, they ate mainly unprocessed or minimally processed foods, and for another two weeks, they ate mainly UPFs. The diets had similar amounts of calories and nutrients, and the participants could eat as much as they wanted at each meal.

During their two weeks on the ultraprocessed diet, participants gained an average of two pounds and consumed about 500 calories more per day than they did on the unprocessed diet

During their time on the unprocessed diet, they lost about two pounds.

That finding might help explain the link between UPFs, obesity and other metabolic conditions

Clinical trials are needed to test if UPFs directly cause health problems, Dr. O’Connor said. Only one such study, which was small and had some limitations, has been done, s

There are many “strong opinions” about why ultraprocessed foods are unhealthy, Dr. Hall said. “But there’s actually not a lot of rigorous science” on what those mechanisms are

Because UPFs are often cheap, convenient and accessible, they’re probably displacing healthier foods from our diets

the foods could be having more direct effects on health. They can be easy to overeat — maybe because they contain hard-to-resist combinations of carbohydrates, sugars, fats and salt, are high-calorie and easy to chew

It’s also possible that resulting blood sugar spikes may damage arteries or ramp up inflammation, or that certain food additives or chemicals may interfere with hormones, cause a “leaky” intestine or disrupt the gut microbiome.

Researchers, including Dr. Hall and Dr. Davy, are beginning to conduct small clinical trials that will test some of these theories.

most researchers think there are various ways the foods are causing harm. “Rarely in nutrition is there a single factor that fully explains the relationship between foods and some health outcome,”

In 2014, Dr. Monteiro helped write new dietary guidelines for Brazil that advised people to avoid ultraprocessed foods.

Other countries like Mexico, Israel and Canada have also explicitly recommended avoiding or limiting UPFs or “highly processed foods.”

the safest course is to avoid them altogether

It’s difficult to know what to do about UPFs in the United States, where so much food is already ultraprocessed and people with lower incomes can be especially dependent on them,

“At the end of the day, they are an important source of food, and food is food,” Dr. Mattei added. “We really cannot vilify them,”

While research continues, expert opinions differ on how people should approach UPFs.

The U.S. dietary guidelines contain no such advice, but an advisory committee is currently looking into the evidence on how UPFs may affect weight gain, which could influence the 2025 guidelines.

to swap flavored yogurt for plain yogurt with fruit, for example, or to buy a fresh loaf from a local bakery instead of packaged bread, if you can afford to do so

Dr. Vadiveloo suggested a more moderate strategy, focusing on limiting UPFs that don’t provide valuable nutrients, like soda and cookies

She also recommended eating more fruits, vegetables, whole grains (ultraprocessed or not), legumes, nuts and seeds.

Cook at home as much as you can, using minimally processed foods

Trump, Robert F. Kennedy Jr., declared that “we are just poisoning the poor citizens” by not including enough vegetables or healthy foods in school lunch programs. Days later, Kennedy appeared on Fox News to rail against seed oils, which he said are “associated with autoimmune injuries and ADHD,” not to mention “depression.” He added:

Kennedy’s insinuation that seed oils cause ADHD, which went unchallenged by the Fox host, is false. The National Institutes of Health actually found in a 2022 study that an “increased dietary intake of polyphenols (some seed oils contain polyphenols) is associated with a lower risk of ADHD in preschool and school children.”

During his administration, the federal government overhauled nutritional standards to strip school lunch programs of fruit and vegetables (worsening the very lack Kennedy decried for “poisoning the poor citizens”). The Trump administration also significantly increased the agricultural subsidies Kennedy described as one of the country’s besetting forms of corruption while simultaneously reducing the FDA’s role in policing food safety.

In the pre-Trump era, Republicans ridiculed Michelle Obama’s school lunch program, which Trump immediately rolled back upon entering the White House. Now many of them are criticizing the poor state of school lunches, but without having the policy chops to offer a better health and nutrition program. Instead, we’re left with a constant stream of conspiracies that flow from the feverish mouths of health cranks.

A study published earlier this year showed how the number of people going hungry in the world had increased for the first time since the turn of the century, sparking concern that climate change and conflict could reverse years of progress. Malnutrition prevents almost a fifth of children in Ghana from growing properly. The problem is particularly acute in Bentum, Apprah and Nyanyano, rural communities with scant medical facilities Roughly 815 million people were going to bed hungry last year, compared with 777 million in 2015.

“The prevailing story is that this is the best of all possible worlds — cheap food, widely available. If you don’t think about it too hard, it makes sense,”

A closer look, however, reveals a much different story, he said. “To put it in stark terms: The diet is killing us.”

Part of the problem, he added, is a natural tendency for people to overeat as they can afford more food.

The prevalence of obesity has doubled in 73 countries since 1980, contributing to four million premature deaths, the study found.

The story is as much about economics as it is nutrition. As multinational companies push deeper into the developing world, they are transforming local agriculture, spurring farmers to abandon subsistence crops in favor of cash commodities like sugar cane, corn and soybeans — the building blocks for many industrial food products.

the rising clout of big food companies also translates into political influence, stymieing public health officials seeking soda taxes or legislation aimed at curbing the health impacts of processed food.

For a growing number of nutritionists, the obesity epidemic is inextricably linked to the sales of packaged foods, which grew 25 percent worldwide from 2011 to 2016, compared with 10 percent in the United States,

The same trends are mirrored with fast food, which grew 30 percent worldwide from 2011 to 2016, compared with 21 percent in the United States

For some companies, that can mean specifically focusing on young people, as Ahmet Bozer, president of Coca-Cola International, described to investors in 2014. “Half the world’s population has not had a Coke in the last 30 days,” he said. “There’s 600 million teenagers who have not had a Coke in the last week. So the opportunity for that is huge.”

, Brazil is a microcosm of how growing incomes and government policies have led to longer, better lives and largely eradicated hunger.

now the country faces a stark new nutrition challenge: over the last decade, the country’s obesity rate has nearly doubled to 20 percent, and the portion of people who are overweight has nearly tripled to 58 percent. Each year, 300,000 people are diagnosed with Type II diabetes, a condition with strong links to obesity.

Lesson #5: Proportionality should be a guideline in war.

McNamara talks about the proportions of cities destroyed in Japan by the US before the dropping of the nuclear bomb, comparing the destroyed Japanese cities to similarly-sized cities in the US: Tokyo, roughly the size of New York City, was 51% destroyed; Toyama, the size of Chattanooga, was 99% destroyed; Nagoya, the size of Los Angeles, was 40% destroyed; Osaka, the size of Chicago, was 35% destroyed; Kobe, the size of Baltimore, was 55% destroyed; etc. He says LeMay once said that, had the United States lost the war, they would have been tried for war crimes, and agrees with this assessment.

Lesson #7: Belief and seeing are both often wrong. McNamara affirms Morris' framing of lesson 7 in relation to the Gulf of Tonkin incident: "We see what we want to believe."

Lesson #8: Be prepared to reexamine your reasoning. McNamara says that, even though the United States is the strongest nation in the world, it should never use that power unilaterally: "if we can't persuade nations with comparable values of the merit of our cause, we better reexamine our reasoning."

we are not omniscient. If we cannot persuade other nations with similar interests and similar values of the merits of the proposed use of that power, we should not proceed unilaterally except in the unlikely requirement to defend directly the continental U.S., Alaska and Hawaii.

We, the richest nation in the world, have failed in our responsibility to our own poor and to the disadvantaged across the world to help them advance their welfare in the most fundamental terms of nutrition, literacy, health and employment.

War is a blunt instrument by which to settle disputes between or within nations, and economic sanctions are rarely effective. Therefore, we should build a system of jurisprudence based on the International Court—that the U.S. has refused to support—which would hold individuals responsible for crimes against humanity.

If we are to deal effectively with terrorists across the globe, we must develop a sense of empathy—I don't mean "sympathy," but rather "understanding"—to counter their attacks on us and the Western World.

We underestimated the power of nationalism to motivate a people to fight and die for their beliefs and values.

Our misjudgments of friend and foe, alike, reflected our profound ignorance of the history, culture, and politics of the people in the area, and the personalities and habits of their leaders.

We failed then—and have since—to recognize the limitations of modern, high-technology military equipment, forces, and doctrine. We failed, as well, to adapt our military tactics to the task of winning the hearts and minds of people from a totally different culture.

We did not recognize that neither our people nor our leaders are omniscient. Our judgment of what is in another people's or country's best interest should be put to the test of open discussion in international forums. We do not have the God-given right to shape every nation in our image or as we choose.

We did not hold to the principle that U.S. military action … should be carried out only in conjunction with multinational forces supported fully (and not merely cosmetically) by the international community.

the mouth feel of soda and many other food items, especially those high in fat, is second only to the bliss point in its ability to predict how much craving a product will induce.

He organized focus-group sessions with the people most responsible for buying bologna — mothers — and as they talked, he realized the most pressing issue for them was time. Working moms strove to provide healthful food, of course, but they spoke with real passion and at length about the morning crush, that nightmarish dash to get breakfast on the table and lunch packed and kids out the door.

as the focus swung toward kids, Saturday-morning cartoons started carrying an ad that offered a different message: “All day, you gotta do what they say,” the ads said. “But lunchtime is all yours.”

When it came to Lunchables, they did try to add more healthful ingredients. Back at the start, Drane experimented with fresh carrots but quickly gave up on that, since fresh components didn’t work within the constraints of the processed-food system, which typically required weeks or months of transport and storage before the food arrived at the grocery store. Later, a low-fat version of the trays was developed, using meats and cheese and crackers that were formulated with less fat, but it tasted inferior, sold poorly and was quickly scrapped.

One of the company’s responses to criticism is that kids don’t eat the Lunchables every day — on top of which, when it came to trying to feed them more healthful foods, kids themselves were unreliable. When their parents packed fresh carrots, apples and water, they couldn’t be trusted to eat them. Once in school, they often trashed the healthful stuff in their brown bags to get right to the sweets.

This idea — that kids are in control — would become a key concept in the evolving marketing campaigns for the trays. In what would prove to be their greatest achievement of all, the Lunchables team would delve into adolescent psychology to discover that it wasn’t the food in the trays that excited the kids; it was the feeling of power it brought to their lives.

The prevailing attitude among the company’s food managers — through the 1990s, at least, before obesity became a more pressing concern — was one of supply and demand. “People could point to these things and say, ‘They’ve got too much sugar, they’ve got too much salt,’ ” Bible said. “Well, that’s what the consumer wants, and we’re not putting a gun to their head to eat it. That’s what they want. If we give them less, they’ll buy less, and the competitor will get our market. So you’re sort of trapped.”

at last count, including sales in Britain, they were approaching the $1 billion mark. Lunchables was more than a hit; it was now its own category

he holds the entire industry accountable. “What do University of Wisconsin M.B.A.’s learn about how to succeed in marketing?” his presentation to the med students asks. “Discover what consumers want to buy and give it to them with both barrels. Sell more, keep your job! How do marketers often translate these ‘rules’ into action on food? Our limbic brains love sugar, fat, salt. . . . So formulate products to deliver these. Perhaps add low-cost ingredients to boost profit margins. Then ‘supersize’ to sell more. . . . And advertise/promote to lock in ‘heavy users.’ Plenty of guilt to go around here!”

men in the eastern part of Finland had the highest rate of fatal cardiovascular disease in the world. Research showed that this plague was not just a quirk of genetics or a result of a sedentary lifestyle — it was also owing to processed foods. So when Finnish authorities moved to address the problem, they went right after the manufacturers. (The Finnish response worked. Every grocery item that was heavy in salt would come to be marked prominently with the warning “High Salt Content.” By 2007, Finland’s per capita consumption of salt had dropped by a third, and this shift — along with improved medical care — was accompanied by a 75 percent to 80 percent decline in the number of deaths from strokes and heart disease.)

I tracked Lin down in Irvine, Calif., where we spent several days going through the internal company memos, strategy papers and handwritten notes he had kept. The documents were evidence of the concern that Lin had for consumers and of the company’s intent on using science not to address the health concerns but to thwart them. While at Frito-Lay, Lin and other company scientists spoke openly about the country’s excessive consumption of sodium and the fact that, as Lin said to me on more than one occasion, “people get addicted to salt

the marketing team was joined by Dwight Riskey, an expert on cravings who had been a fellow at the Monell Chemical Senses Center in Philadelphia, where he was part of a team of scientists that found that people could beat their salt habits simply by refraining from salty foods long enough for their taste buds to return to a normal level of sensitivity. He had also done work on the bliss point, showing how a product’s allure is contextual, shaped partly by the other foods a person is eating, and that it changes as people age. This seemed to help explain why Frito-Lay was having so much trouble selling new snacks. The largest single block of customers, the baby boomers, had begun hitting middle age. According to the research, this suggested that their liking for salty snacks — both in the concentration of salt and how much they ate — would be tapering off.

Riskey realized that he and his colleagues had been misreading things all along. They had been measuring the snacking habits of different age groups and were seeing what they expected to see, that older consumers ate less than those in their 20s. But what they weren’t measuring, Riskey realized, is how those snacking habits of the boomers compared to themselves when they were in their 20s. When he called up a new set of sales data and performed what’s called a cohort study, following a single group over time, a far more encouraging picture — for Frito-Lay, anyway — emerged. The baby boomers were not eating fewer salty snacks as they aged. “In fact, as those people aged, their consumption of all those segments — the cookies, the crackers, the candy, the chips — was going up,” Riskey said. “They were not only eating what they ate when they were younger, they were eating more of it.” In fact, everyone in the country, on average, was eating more salty snacks than they used to. The rate of consumption was edging up about one-third of a pound every year, with the average intake of snacks like chips and cheese crackers pushing past 12 pounds a year

Riskey had a theory about what caused this surge: Eating real meals had become a thing of the past.

“We looked at this behavior, and said, ‘Oh, my gosh, people were skipping meals right and left,’ ” Riskey told me. “It was amazing.” This led to the next realization, that baby boomers did not represent “a category that is mature, with no growth. This is a category that has huge growth potential.”

The food technicians stopped worrying about inventing new products and instead embraced the industry’s most reliable method for getting consumers to buy more: the line extension.

He zeroed right in on the Cheetos. “This,” Witherly said, “is one of the most marvelously constructed foods on the planet, in terms of pure pleasure.” He ticked off a dozen attributes of the Cheetos that make the brain say more. But the one he focused on most was the puff’s uncanny ability to melt in the mouth. “It’s called vanishing caloric density,” Witherly said. “If something melts down quickly, your brain thinks that there’s no calories in it . . . you can just keep eating it forever.”

Frito-Lay acquired Stacy’s Pita Chip Company, which was started by a Massachusetts couple who made food-cart sandwiches and started serving pita chips to their customers in the mid-1990s. In Frito-Lay’s hands, the pita chips averaged 270 milligrams of sodium — nearly one-fifth a whole day’s recommended maximum for most American adults — and were a huge hit among boomers.

There’s a paradox at work here. On the one hand, reduction of sodium in snack foods is commendable. On the other, these changes may well result in consumers eating more. “The big thing that will happen here is removing the barriers for boomers and giving them permission to snack,” Carey said. The prospects for lower-salt snacks were so amazing, he added, that the company had set its sights on using the designer salt to conquer the toughest market of all for snacks: schools

The company’s chips, he wrote, were not selling as well as they could for one simple reason: “While people like and enjoy potato chips, they feel guilty about liking them. . . . Unconsciously, people expect to be punished for ‘letting themselves go’ and enjoying them.” Dichter listed seven “fears and resistances” to the chips: “You can’t stop eating them; they’re fattening; they’re not good for you; they’re greasy and messy to eat; they’re too expensive; it’s hard to store the leftovers; and they’re bad for children.” He spent the rest of his memo laying out his prescriptions, which in time would become widely used not just by Frito-Lay but also by the entire industry.

Dichter advised Frito-Lay to move its chips out of the realm of between-meals snacking and turn them into an ever-present item in the American diet. “The increased use of potato chips and other Lay’s products as a part of the regular fare served by restaurants and sandwich bars should be encouraged in a concentrated way,”

the largest weight-inducing food was the potato chip. The coating of salt, the fat content that rewards the brain with instant feelings of pleasure, the sugar that exists not as an additive but in the starch of the potato itself — all of this combines to make it the perfect addictive food. “The starch is readily absorbed,” Eric Rimm, an associate professor of epidemiology and nutrition at the Harvard School of Public Health and one of the study’s authors, told me. “More quickly even than a similar amount of sugar. The starch, in turn, causes the glucose levels in the blood to spike” — which can result in a craving for more.

If Americans snacked only occasionally, and in small amounts, this would not present the enormous problem that it does. But because so much money and effort has been invested over decades in engineering and then relentlessly selling these products, the effects are seemingly impossible to unwind.

Todd Putman, who worked at Coca-Cola from 1997 to 2001, said the goal became much larger than merely beating the rival brands; Coca-Cola strove to outsell every other thing people drank, including milk and water. The marketing division’s efforts boiled down to one question, Putman said: “How can we drive more ounces into more bodies more often?”

In practice, or perhaps out of necessity, the Democratic Party in 2006 and 2008 chose the upscale white-downscale minority approach that proved highly successful twice, but failed miserably in 2010, and appears to have a 50-50 chance in 2012.

Calmes and Landler describe how Obama’s re-election campaign plans to deal with the decline in white working class support in Rust Belt states by concentrating on states with high percentages of college educated voters, including Colorado, Virginia and New Hampshire.

“My sense is that if the Democrats stopped fishing there, it is because there are no fish.”

As a practical matter, the Obama campaign and, for the present, the Democratic Party, have laid to rest all consideration of reviving the coalition nurtured and cultivated by Franklin D. Roosevelt. The New Deal Coalition — which included unions, city machines, blue-collar workers, farmers, blacks, people on relief, and generally non-affluent progressive intellectuals — had the advantage of economic coherence. It received support across the board from voters of all races and religions in the bottom half of the income distribution, the very coherence the current Democratic coalition lacks.

A top priority of the less affluent wing of today’s left alliance is the strengthening of the safety net, including health care, food stamps, infant nutrition and unemployment compensation. These voters generally take the brunt of recessions and are most in need of government assistance to survive. According to recent data from the Department of Agriculture, 45.8 million people, nearly 15 percent of the population, depend on the Supplemental Nutrition Assistance Program to meet their needs for food.The better-off wing, in contrast, puts at the top of its political agenda a cluster of rights related to self-expression, the environment, demilitarization, and, importantly, freedom from repressive norms — governing both sexual behavior and women’s role in society — that are promoted by the conservative movement.

“GMO will make Ghanaian farmers poor” and “Our Food Under Our Control!!!”

Monsanto is also part of the New Alliance for Food Security and Nutrition, a group of private corporations tasked by the G8 to invest in solutions to African hunger over the next decade.

Hating Monsanto is “a luxury when you’re surrounded by food 24/7,” writes one defender, who argues that spreading negative sentiment against the company actually “impedes global economic growth.” Even Britain’s Environmental Secretary, Owen Paterson, said organizations fighting the spread of GMOs are “absolutely wicked” and “cast a dark shadow over attempts to feed the world.”

But African farmers also have very legitimate concerns about Monsanto’s reputation for investigating, suing, and ruining farmers who try to save GM seeds.

ood Sovereignty Ghana warns against the “control of our resources by multinational corporations and other foreign entities,” and the “avaricious calculations behind the proposition that food is just another commodity or component for international agribusiness.”

they call for “collective control over our collective resources.”

ontroversial GM golden rice, which is supposed to pump up Vitamin A levels in regular rice to make it more nutritious, could well be a promising use of technology

However, golden rice is still mainly theoretical after a decade of research.

hunger is not caused by a food shortage but by “a lack of purchasing power and/or the inability of the rural poor to be self-sufficient.”

What is clear is that, despite years of Western involvement and billions of dollars in humanitarian aid to Afghanistan, children’s health is not only still a problem, but also worsening, and the doctors bearing the brunt of the crisis are worried.

Nearly every potential lifeline is strained or broken here. Efforts to educate people about nutrition and health care are often stymied by conservative traditions that cloister women away from anyone outside the family. Agriculture and traditional local sources of social support have been disrupted by war and the widespread flight of refugees to the cities. And therapeutic feeding programs, complex operations even in countries with strong health care systems, have been compromised as the flow of aid and transportation have been derailed by political tensions or violence.

Perhaps nowhere is the situation so obviously serious as in the malnutrition ward at Bost Hospital, which is admitting 200 children a month for severe, acute malnutrition — four times more than it did in January 2012, according to officials with Doctors Without Borders, known in French as Médecins Sans Frontières, which supports the Afghan-run hospital with financing and supplementary staff.

One patient, a 2-year-old named Ahmed Wali, is suffering from the protein deficiency condition kwashiorkor, with orange hair, a distended belly and swollen feet. An 8-month-old boy named Samiullah is suffering from marasmus, another form of advanced malnutrition in which the child’s face looks like that of a wrinkled old man because the skin hangs so loosely.

Médecins Sans Frontières helped Bost Hospital nearly double the number of beds in the pediatric wing at the end of last year, and there are still not enough — 40 to 50 children are usually being treated each day, mostly two to a bed because they are so small. Nearly 300 other children, less severely malnourished, are in an outpatient therapeutic feeding program.

“It’s quite an unusual situation, and it’s difficult to understand what’s going on,” said Wiet Vandormael, an M.S.F. official who has helped coordinate with Bost Hospital.

Coca-Cola and other multinational food companies, operating through a group called the International Life Sciences Institute, cultivated key Chinese officials in an effort to stave off the growing movement for food regulation and soda taxes that has been sweeping the west.

in China, ILSI is so well-placed that it runs its operations from inside the government’s Centre for Disease Control and Prevention in Beijing. In fact, when asked to comment on the studies, the ministry emailed a statement not from a government official but from ILSI’s China director.

The close relationship with the highest government health policymakers goes significantly beyond what the companies have been able to achieve in the West.

Professor Popkin was not involved in the study, but he has spent decades working in China to help the country develop nutrition guidelines and food policy — efforts he said were often thwarted by well-placed officials aligned with ILSI.Given his experience, he said Professor Greenhalgh’s findings were not surprising. “Over the course of several decades, Coke and ILSI have worked to prevent any kind of food policy that would benefit public health,” he said. “What they’ve been doing in China is insidious.”

the industry efforts have been wildly successful, in part because China lacks a free media or watchdog organizations that might have been critical of the relationship.

In just a few decades, China has gone from a nation plagued by food shortages to one buffeted by soaring obesity and chronic diseases tied to poor diet. More than 42 percent of adults in China are overweight or obese, according to Chinese researchers, more than double the rate in 1991. In Chinese cities, nearly a fifth of all children are obese, according to government surveys.

“The key is that no matter what Cola-Cola or other beverage companies say, these drinks are just a product,” he said. “No one is being forced to buy them.”

These groups, he said, support and publicize scientific studies whose results sometimes muddy the waters on contentious issues like smoking or alcohol and soda consumption.“They often cherry pick data in ways that mislead while portraying these issues as so terribly complex that nothing can be done,” he said.

A new report from the body found that raising prices by 20% or more results in lower consumption and "improved nutrition".

"Free sugars" are all the different types of sugar in the diet, except for the sugars that are found naturally in fruit and milk.

The WHO's nutrition director, Dr Francesco Branca, said "nutritionally, people don't need any sugar in their diet".

He recommended sugar intake be kept below 10% of a person's total calorie intake - and preferably below 5%.

It also said that the same tax measures levied against sugary drinks appear to work with other sugary foods, as well as those high in saturated fats, trans fats, and salt.

“Early indications are that demand for plant-based proteins will continue to grow,” said Tony Weisman, chief marketing officer with Dunkin’ US. He said the company intended to roll out its new Beyond Sausage sandwich nationally soon.

fast-food options including Beyond Meat and Impossible Foods are neither organic nor particularly healthy.

whether health-conscious young people will come out in droves for plant-based fast food remains to be seen.

The Impossible Whopper meal, which automatically comes with a medium fries and Coke, is a staggering 1,280 calories. There are 34 grams of fat and 1,080 grams of sodium in the sandwich alone.

“It’s difficult to say which one is healthier, because ultimately we know a burger is not a healthy choice,”

Similarly, Dunkin’s Beyond Sausage breakfast sandwich is a nutritional bomb at 470 calories, 24 grams of fat and 910 milligrams of sodium. If a person ate both in one day, they would have eaten 1,750 calories before dinner, leaving them with 250 calories for the day if they followed the recommended 2,000 calorie per day diet.

A future where Impossible Foods or Beyond Beef – or any other single-source supplier – might dominate the market also poses a problem for restaurants like Burger King. Impossible Burgers and Beyond Meat sausages are dependent on Silicon Valley intellectual property rights. It would be a huge economic risk for burger joints to shift their menus toward these products, because they would be held hostage by a single supplier with the magic ingredient.

mong other measures, the new legislation caps loans at $2 million and makes them available only to borrowers with fewer than 300 employees that experienced at least a 25 percent drop in sales from a year earlier in at least one quarter. The agreement also sets aside $12 billion specifically for minority-owned businesses.

Clearing a longstanding legislative impasse, the deal will also help millions of Americans avoid unexpected — and often exorbitant — medical bills that can spawn from visits to hospitals.

Overall, the legislation provides $13 billion for increased nutrition assistance, $400 million of which will support food banks and food pantries. An additional $175 million is earmarked for nutrition programs under the Older Americans Act, such as Meals on Wheels.

CORRECTION: An earlier version of this story mischaracterized how the Hatch Act applies to members of the President's Council on Sports, Fitness & Nutrition. Oz and Walker were in violation of a Biden administration policy, not the Hatch Act. The story has also been updated with additional reaction.

The ordinary fixes—the kind that draw on people’s will, and require eating less and moving more—rarely have a large or lasting effect. Indeed, America itself has suffered through a long, maddening history of failed attempts to change its habits on a national scale: a yo-yo diet of well-intentioned treatments, policies, and other social interventions that only ever lead us back to where we started

Through it all, obesity rates keep going up; the diabetes epidemic keeps worsening.

The most recent miracle, for Barb as well as for the nation, has come in the form of injectable drugs. In early 2021, the Danish pharmaceutical company Novo Nordisk published a clinical trial showing remarkable results for semaglutide, now sold under the trade names Wegovy and Ozempic.

Patients in the study who’d had injections of the drug lost, on average, close to 15 percent of their body weight—more than had ever been achieved with any other drug in a study of that size. Wadden knew immediately that this would be “an incredible revolution in the treatment of obesity.”

Many more drugs are now racing through development: survodutide, pemvidutide, retatrutide. (Among specialists, that last one has produced the most excitement: An early trial found an average weight loss of 24 percent in one group of participants.

In the United States, an estimated 189 million adults are classified as having obesity or being overweight

The drugs don’t work for everyone. Their major side effects—nausea, vomiting, and diarrhea—can be too intense for many patients. Others don’t end up losing any weight

For the time being, just 25 percent of private insurers offer the relevant coverage, and the cost of treatment—about $1,000 a month—has been prohibitive for many Americans.

The drugs have already been approved not just for people with diabetes or obesity, but for anyone who has a BMI of more than 27 and an associated health condition, such as high blood pressure or cholesterol. By those criteria, more than 140 million American adults already qualify

if this story goes the way it’s gone for other “risk factor” drugs such as statins and antihypertensives, then the threshold for prescriptions will be lowered over time, inching further toward the weight range we now describe as “normal.”

How you view that prospect will depend on your attitudes about obesity, and your tolerance for risk

The first GLP-1 drug to receive FDA approval, exenatide, has been used as a diabetes treatment for more than 20 years. No long-term harms have been identified—but then again, that drug’s long-term effects have been studied carefully only across a span of seven years

the data so far look very good. “These are now being used, literally, in hundreds of thousands of people across the world,” she told me, and although some studies have suggested that GLP-1 drugs may cause inflammation of the pancreas, or even tumor growth, these concerns have not borne out.

adolescents are injecting newer versions of these drugs, and may continue to do so every week for 50 years or more. What might happen over all that time?

“All of us, in the back of our minds, always wonder, Will something show up?  ” Although no serious problems have yet emerged, she said, “you wonder, and you worry.”

in light of what we’ve been through, it’s hard to see what other choices still remain. For 40 years, we’ve tried to curb the spread of obesity and its related ailments, and for 40 years, we’ve failed. We don’t know how to fix the problem. We don’t even understand what’s really causing it. Now, again, we have a new approach. This time around, the fix had better work.

The fen-phen revolution arrived at a crucial turning point for Wadden’s field, and indeed for his career. By then he’d spent almost 15 years at the leading edge of research into dietary interventions, seeing how much weight a person might lose through careful cutting of their calories.

But that sort of diet science—and the diet culture that it helped support—had lately come into a state of ruin. Americans were fatter than they’d ever been, and they were giving up on losing weight. According to one industry group, the total number of dieters in the country declined by more than 25 percent from 1986 to 1991.

Rejecting diet culture became something of a feminist cause. “A growing number of women are joining in an anti-diet movement,” The New York Times reported in 1992. “They are forming support groups and ceasing to diet with a resolve similar to that of secretaries who 20 years ago stopped getting coffee for their bosses.

Now Wadden and other obesity researchers were reaching a consensus that behavioral interventions might produce in the very best scenario an average lasting weight loss of just 5 to 10 percent

National surveys completed in 1994 showed that the adult obesity rate had surged by more than half since 1980, while the proportion of children classified as overweight had doubled. The need for weight control in America had never seemed so great, even as the chances of achieving it were never perceived to be so small.

Wadden wasn’t terribly concerned, because no one in his study had reported any heart symptoms. But ultrasounds revealed that nearly one-third of them had some degree of leakage in their heart valves. His “cure for obesity” was in fact a source of harm.

In December 1994, the Times ran an editorial on what was understood to be a pivotal discovery: A genetic basis for obesity had finally been found. Researchers at Rockefeller University were investigating a molecule, later named leptin, that gets secreted from fat cells and travels to the brain, and that causes feelings of satiety. Lab mice with mutations in the leptin gene—importantly, a gene also found in humans—overeat until they’re three times the size of other mice. “The finding holds out the dazzling hope,”

In April 1996, the doctors recommended yes: Dexfenfluramine was approved—and became an instant blockbuster. Patients received prescriptions by the hundreds of thousands every month. Sketchy wellness clinics—call toll-free, 1-888-4FEN-FEN—helped meet demand. Then, as now, experts voiced concerns about access. Then, as now, they worried that people who didn’t really need the drugs were lining up to take them. By the end of the year, sales of “fen” alone had surpassed $300 million.

It was nothing less than an awakening, for doctors and their patients alike. Now a patient could be treated for excess weight in the same way they might be treated for diabetes or hypertension—with a drug they’d have to take for the rest of their life.

the article heralded a “new understanding of obesity as a chronic disease rather than a failure of willpower.”

News had just come out that, at the Mayo Clinic in Minnesota, two dozen women taking fen-phen—including six who were, like Barb, in their 30s—had developed cardiac conditions. A few had needed surgery, and on the operating table, doctors discovered that their heart valves were covered with a waxy plaque.

Americans had been prescribed regular fenfluramine since 1973, and the newer drug, dexfenfluramine, had been available in France since 1985. Experts took comfort in this history. Using language that is familiar from today’s assurances regarding semaglutide and other GLP-1 drugs, they pointed out that millions were already on the medication. “It is highly unlikely that there is anything significant in toxicity to the drug that hasn’t been picked up with this kind of experience,” an FDA official named James Bilstad would later say in a Time cover story headlined “The Hot New Diet Pill.

“I know I can’t get any more,” she told Williams. “I have to use up what I have. And then I don’t know what I’m going to do after that. That’s the problem—and that is what scares me to death.” Telling people to lose weight the “natural way,” she told another guest, who was suggesting that people with obesity need only go on low-carb diets, is like “asking a person with a thyroid condition to just stop their medication.”

She’d gone off the fen-phen and had rapidly regained weight. “The voices returned and came back in a furor I’d never heard before,” Barb later wrote on her blog. “It was as if they were so angry at being silenced for so long, they were going to tell me 19 months’ worth of what they wanted me to hear. I was forced to listen. And I ate. And I ate. And ate.”

For Barb, rapid weight loss has brought on a different metaphysical confusion. When she looks in the mirror, she sometimes sees her shape as it was two years ago. In certain corners of the internet, this is known as “phantom fat syndrome,” but Barb dislikes that term. She thinks it should be called “body integration syndrome,” stemming from a disconnect between your “larger-body memory” and “smaller-body reality.

In 2003, the U.S. surgeon general declared obesity “the terror within, a threat that is every bit as real to America as the weapons of mass destruction”; a few months later, Eric Finkelstein, an economist who studies the social costs of obesity, put out an influential paper finding that excess weight was associated with up to $79 billion in health-care spending in 1998, of which roughly half was paid by Medicare and Medicaid. (Later he’d conclude that the number had nearly doubled in a decade.

In 2004, Finkelstein attended an Action on Obesity summit hosted by the Mayo Clinic, at which numerous social interventions were proposed, including calorie labeling in workplace cafeterias and mandatory gym class for children of all grades.

he message at their core, that soda was a form of poison like tobacco, spread. In San Francisco and New York, public-service campaigns showed images of soda bottles pouring out a stream of glistening, blood-streaked fat. Michelle Obama led an effort to depict water—plain old water—as something “cool” to drink.

Soon, the federal government took up many of the ideas that Brownell had helped popularize. Barack Obama had promised while campaigning for president that if America’s obesity trends could be reversed, the Medicare system alone would save “a trillion dollars.” By fighting fat, he implied, his ambitious plan for health-care reform would pay for itself. Once he was in office, his administration pulled every policy lever it could.

Michelle Obama helped guide these efforts, working with marketing experts to develop ways of nudging kids toward better diets and pledging to eliminate “food deserts,” or neighborhoods that lacked convenient access to healthy, affordable food. She was relentless in her public messaging; she planted an organic garden at the White House and promoted her signature “Let’s Move!” campaign around the country.

An all-out war on soda would come to stand in for these broad efforts. Nutrition studies found that half of all Americans were drinking sugar-sweetened beverages every day, and that consumption of these accounted for one-third of the added sugar in adults’ diets. Studies turned up links between people’s soft-drink consumption and their risks for type 2 diabetes and obesity. A new strand of research hinted that “liquid calories” in particular were dangerous to health.

when their field lost faith in low-calorie diets as a source of lasting weight loss, the two friends went in opposite directions. Wadden looked for ways to fix a person’s chemistry, so he turned to pharmaceuticals. Brownell had come to see obesity as a product of our toxic food environment: He meant to fix the world to which a person’s chemistry responded, so he started getting into policy.

The social engineering worked. Slowly but surely, Americans’ lamented lifestyle began to shift. From 2001 to 2018, added-sugar intake dropped by about one-fifth among children, teens, and young adults. From the late 1970s through the early 2000s, the obesity rate among American children had roughly tripled; then, suddenly, it flattened out.

although the obesity rate among adults was still increasing, its climb seemed slower than before. Americans’ long-standing tendency to eat ever-bigger portions also seemed to be abating.

sugary drinks—liquid candy, pretty much—were always going to be a soft target for the nanny state. Fixing the food environment in deeper ways proved much harder. “The tobacco playbook pretty much only works for soda, because that’s the closest analogy we have as a food item,

that tobacco playbook doesn’t work to increase consumption of fruits and vegetables, he said. It doesn’t work to increase consumption of beans. It doesn’t work to make people eat more nuts or seeds or extra-virgin olive oil.

Careful research in the past decade has shown that many of the Obama-era social fixes did little to alter behavior or improve our health. Putting calorie labels on menus seemed to prompt at most a small decline in the amount of food people ate. Employer-based wellness programs (which are still offered by 80 percent of large companies) were shown to have zero tangible effects. Health-care spending, in general, kept going up.

From the mid-1990s to the mid-2000s, the proportion of adults who said they’d experienced discrimination on account of their height or weight increased by two-thirds, going up to 12 percent. Puhl and others started citing evidence that this form of discrimination wasn’t merely a source of psychic harm, but also of obesity itself. Studies found that the experience of weight discrimination is associated with overeating, and with the risk of weight gain over time.

obesity rates resumed their ascent. Today, 20 percent of American children have obesity. For all the policy nudges and the sensible revisions to nutrition standards, food companies remain as unfettered as they were in the 1990s, Kelly Brownell told me. “Is there anything the industry can’t do now that it was doing then?” he asked. “The answer really is no. And so we have a very predictable set of outcomes.”

she started to rebound. The openings into her gastric pouch—the section of her stomach that wasn’t bypassed—stretched back to something like their former size. And Barb found ways to “eat around” the surgery, as doctors say, by taking food throughout the day in smaller portions

Bariatric surgeries can be highly effective for some people and nearly useless for others. Long-term studies have found that 30 percent of those who receive the same procedure Barb did regain at least one-quarter of what they lost within two years of reaching their weight nadir; more than half regain that much within five years.

if the effects of Barb’s surgery were quickly wearing off, its side effects were not: She now had iron, calcium, and B12 deficiencies resulting from the changes to her gut. She looked into getting a revision of the surgery—a redo, more or less—but insurance wouldn’t cover it

She found that every health concern she brought to doctors might be taken as a referendum, in some way, on her body size. “If I stubbed my toe or whatever, they’d just say ‘Lose weight.’ ” She began to notice all the times she’d be in a waiting room and find that every chair had arms. She realized that if she was having a surgical procedure, she’d need to buy herself a plus-size gown—or else submit to being covered with a bedsheet when the nurses realized that nothing else would fit.

Barb grew angrier and more direct about her needs—You’ll have to find me a different chair, she started saying to receptionists. Many others shared her rage. Activists had long decried the cruel treatment of people with obesity: The National Association to Advance Fat Acceptance had existed, for example, in one form or another, since 1969; the Council on Size & Weight Discrimination had been incorporated in 1991. But in the early 2000s, the ideas behind this movement began to wend their way deeper into academia, and they soon gained some purchase with the public.

“Our public-health efforts to address obesity have failed,” Eric Finkelstein, the economist, told me.

Others attacked the very premise of a “healthy weight”: People do not have any fundamental need, they argued, morally or medically, to strive for smaller bodies as an end in itself. They called for resistance to the ideology of anti-fatness, with its profit-making arms in health care and consumer goods. The Association for Size Diversity and Health formed in 2003; a year later, dozens of scholars working on weight-related topics joined together to create the academic field of fat studies.

As the size-diversity movement grew, its values were taken up—or co-opted—by Big Business. Dove had recently launched its “Campaign for Real Beauty,” which included plus-size women. (Ad Age later named it the best ad campaign of the 21st century.) People started talking about “fat shaming” as something to avoid

By 2001, Bacon, who uses they/them pronouns, had received their Ph.D. and finished a rough draft of a book, Health at Every Size, which drew inspiration from a broader movement by that name among health-care practitioners

But something shifted in the ensuing years. In 2007, Bacon got a different response, and the book was published. Health at Every Size became a point of entry for a generation of young activists and, for a time, helped shape Americans’ understanding of obesity.

Some experts were rethinking their advice on food and diet. At UC Davis, a physiologist named Lindo Bacon who had struggled to overcome an eating disorder had been studying the effects of “intuitive eating,” which aims to promote healthy, sustainable behavior without fixating on what you weigh or how you look

The heightened sensitivity started showing up in survey data, too. In 2010, fewer than half of U.S. adults expressed support for giving people with obesity the same legal protections from discrimination offered to people with disabilities. In 2015, that rate had risen to three-quarters.

In Bacon’s view, the 2000s and 2010s were glory years. “People came together and they realized that they’re not alone, and they can start to be critical of the ideas that they’ve been taught,” Bacon told me. “We were on this marvelous path of gaining more credibility for the whole Health at Every Size movement, and more awareness.”

that sense of unity proved short-lived; the movement soon began to splinter. Black women have the highest rates of obesity, and disproportionately high rates of associated health conditions. Yet according to Fatima Cody Stanford, an obesity-medicine physician at Harvard Medical School, Black patients with obesity get lower-quality care than white patients with obesity.

That system was exactly what Bacon and the Health at Every Size movement had set out to reform. The problem, as they saw it, was not so much that Black people lacked access to obesity medicine, but that, as Bacon and the Black sociologist Sabrina Strings argued in a 2020 article, Black women have been “specifically targeted” for weight loss, which Bacon and Strings saw as a form of racism

But members of the fat-acceptance movement pointed out that their own most visible leaders, including Bacon, were overwhelmingly white. “White female dietitians have helped steal and monetize the body positive movement,” Marquisele Mercedes, a Black activist and public-health Ph.D. student, wrote in September 2020. “And I’m sick of it.”

Tensions over who had the standing to speak, and on which topics, boiled over. In 2022, following allegations that Bacon had been exploitative and condescending toward Black colleagues, the Association for Size Diversity and Health expelled them from its ranks and barred them from attending its events.

As the movement succumbed to in-fighting, its momentum with the public stalled. If attitudes about fatness among the general public had changed during the 2000s and 2010s, it was only to a point. The idea that some people can indeed be “fit but fat,” though backed up by research, has always been a tough sell.

Although Americans had become less inclined to say they valued thinness, measures of their implicit attitudes seemed fairly stable. Outside of a few cities such as San Francisco and Madison, Wisconsin, new body-size-discrimination laws were never passed.

In the meantime, thinness was coming back into fashion

In the spring of 2022, Kim Kardashian—whose “curvy” physique has been a media and popular obsession—boasted about crash-dieting in advance of the Met Gala. A year later, the model and influencer Felicity Hayward warned Vogue Business that “plus-size representation has gone backwards.” In March of this year, the singer Lizzo, whose body pride has long been central to her public persona, told The New York Times that she’s been trying to lose weight. “I’m not going to lie and say I love my body every day,” she said.

Among the many other dramatic effects of the GLP-1 drugs, they may well have released a store of pent-up social pressure to lose weight.

If ever there was a time to debate that impulse, and to question its origins and effects, it would be now. But Puhl told me that no one can even agree on which words are inoffensive. The medical field still uses obesity, as a description of a diagnosable disease. But many activists despise that phrase—some spell it with an asterisk in place of the e—and propose instead to reclaim fat.

Everyone seems to agree on the most important, central fact: that we should be doing everything we can to limit weight stigma. But that hasn’t been enough to stop the arguing.

Things feel surreal these days to just about anyone who has spent years thinking about obesity. At 71, after more than four decades in the field, Thomas Wadden now works part-time, seeing patients just a few days a week. But the arrival of the GLP-1 drugs has kept him hanging on for a few more years, he said. “It’s too much of an exciting period to leave obesity research right now.”

When everyone is on semaglutide or tirzepatide, will the soft-drink companies—Brownell’s nemeses for so many years—feel as if a burden has been lifted? “My guess is the food industry is probably really happy to see these drugs come along,” he said. They’ll find a way to reach the people who are taking GLP‑1s, with foods and beverages in smaller portions, maybe. At the same time, the pressures to cut back on where and how they sell their products will abate.

the triumph in obesity treatment only highlights the abiding mystery of why Americans are still getting fatter, even now

Perhaps one can lay the blame on “ultraprocessed” foods, he said. Maybe it’s a related problem with our microbiomes. Or it could be that obesity, once it takes hold within a population, tends to reproduce itself through interactions between a mother and a fetus. Others have pointed to increasing screen time, how much sleep we get, which chemicals are in the products that we use, and which pills we happen to take for our many other maladies.

“The GLP-1s are just a perfect example of how poorly we understand obesity,” Mozaffarian told me. “Any explanation of why they cause weight loss is all post-hoc hand-waving now, because we have no idea. We have no idea why they really work and people are losing weight.”

The new drugs—and the “new understanding of obesity” that they have supposedly occasioned—could end up changing people’s attitudes toward body size. But in what ways

When the American Medical Association declared obesity a disease in 2013, Rebecca Puhl told me, some thought “it might reduce stigma, because it was putting more emphasis on the uncontrollable factors that contribute to obesity.” Others guessed that it would do the opposite, because no one likes to be “diseased.”

why wasn’t there another kind of nagging voice that wouldn’t stop—a sense of worry over what the future holds? And if she wasn’t worried for herself, then what about for Meghann or for Tristan, who are barely in their 40s? Wouldn’t they be on these drugs for another 40 years, or even longer? But Barb said she wasn’t worried—not at all. “The technology is so much better now.” If any problems come up, the scientists will find solutions.

“why not go whole hog” (forgive me) “and advocate a strictly vegan diet?” Isn’t being a part-time vegan, the more strident demand, like being a little bit pregnant?

You might think of patterns of eating as falling on one point or another along a spectrum, and moving toward the plant-based end of that spectrum — as opposed to the end represented by Morgan Spurlock’s “super-sized” diet — is almost always beneficial.[7] It is about eating better, or well, not perfectly, and it must be said that “perfectly” has not yet been defined.

This much is known, now: We produce most animal products in deplorable conditions, and some of our health and environmental problems can be traced both to dominant production methods and our overconsumption. But we like to eat them, and they’re a pleasurable and even healthy part of many traditional diets and even sound agricultural practices.