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The study demonstrates this with the same level of confidence that linked cigarettes and lung cancer in the 1960s.

“You could not enact a real-world study that would be more conclusive than this one.”

The study controlled for poverty, urbanization, aging, obesity and physical activity. It controlled for other foods and total calories. In short, it controlled for everything controllable, and it satisfied the longstanding “Bradford Hill” criteria for what’s called medical inference of causation by linking dose (the more sugar that’s available, the more occurrences of diabetes); duration (if sugar is available longer, the prevalence of diabetes increases); directionality (not only does diabetes increase with more sugar, it decreases with less sugar); and precedence (diabetics don’t start consuming more sugar; people who consume more sugar are more likely to become diabetics).

for every 12 ounces of sugar-sweetened beverage introduced per person per day into a country’s food system, the rate of diabetes goes up 1 percent. (The study found no significant difference in results between those countries that rely more heavily on high-fructose corn syrup and those that rely primarily on cane sugar.)

the closest thing to causation and a smoking gun that we will see.

just as tobacco companies fought, ignored, lied and obfuscated in the ’60s (and, indeed, through the ’90s), the pushers of sugar will do the same now.

The next steps are obvious, logical, clear and up to the Food and Drug Administration. To fulfill its mission, the agency must respond to this information by re-evaluating the toxicity of sugar, arriving at a daily value — how much added sugar is safe? — and ideally removing fructose (the “sweet” molecule in sugar that causes the damage) from the “generally recognized as safe” list,

Perhaps most important, as a number of scientists have been insisting in recent years, all calories are not created equal. By definition, all calories give off the same amount of energy when burned, but your body treats sugar calories differently, and that difference is damaging.

it’s become clear that obesity itself is not the cause of our dramatic upswing in chronic disease. Rather, it’s metabolic syndrome, which can strike those of “normal” weight as well as those who are obese. Metabolic syndrome is a result of insulin resistance, which appears to be a direct result of consumption of added sugars

it isn’t simply overeating that can make you sick; it’s overeating sugar.

A study published in the Feb. 27 issue of the journal PLoS One links increased consumption of sugar with increased rates of diabetes by examining the data on sugar availability and the rate of diabetes in 175 countries over the past decade

In other words, according to this study, it’s not just obesity that can cause diabetes: sugar can cause it, too, irrespective of obesity. And obesity does not always lead to diabetes.

But as Lustig says, “This study is proof enough that sugar is toxic. Now it’s time to do something about it.”

The study found that increased sugar in a population’s food supply was linked to higher rates of diabetes — independent of obesity rates — but stopped short of stating that sugar caused diabetes.

This explains why there’s little argument from scientific quarters about the “obesity won’t kill you” studies; technically, they’re correct, because obesity is a marker for metabolic syndrome, not a cause.

Obesity is, in fact, a major risk factor for Type 2 diabetes, as the study noted.

When you see someone spooning sugar onto a bowl of cornflakes or Cheerios, you should not see the act as sweetening something that’s good for you, you should see it as someone spooning sugar onto sugar.

the biggest culprits in America’s bad health are sugar and refined grains, in that order. sugar, a carbohydrate, now seems to be the chief villain. (In his recent book “The Case Against sugar,” Taubes suggests it should be considered toxic in the same way cigarettes are.) But its nutritional cousin, the refined-grain carbohydrate, may be a close second.

Cereal was not always the morning staple that it is today. It only became so at about the same time that our health problems began to be documented, in the 1960s. A coincidence?

cereal was initially eaten on Sundays, when the women of our churchgoing nation didn’t have time to make the family breakfast. Once women entered the workforce, though, we began pouring our convenient breakfasts out of a box in significant numbers daily, a trend that peaked in 1995,

it may not even just be cereal that’s had such a huge impact on American health. “Maybe the problem,” Sukol said, “is the huge quantity of nutritionally bankrupt foods that are supposed to stand in for breakfast.”

By this she means anything composed primarily of refined wheat, which would be, um, 90 percent of the American breakfast repertoire: pancakes, waffles, bagels, toast, muffins, biscuits, scones, croissants, and so on.

eating this stuff on an empty stomach (i.e. in the morning), may be especially bad for your system, as there is little fiber, fat or protein in your system to slow the sugar absorption. Our breakfast staples might all best be considered as a single category of food: sugar bomb.

she nevertheless recommends that all her patients avoid what she calls “stripped” carbs, carbohydrates stripped of their fiber matrix, before noon.

What does she recommend for breakfast? Steel-cut oats, not cooked but rather soaked overnight with a dash of vinegar. I add whole-fat Greek yogurt and some nuts if I have them

Beans are great too. I had a delicious dish of lentils and a small amount of basmati rice

An egg and some cheese are also a nourishing and satisfying way to begin the day.

it throws a different light on the cereal aisle. That hulking behemoth in the middle of the grocery store, the racks of cereal, is stripped-carb and sugar ground zero, representing a kind of unrecognized terrorism wrought on parents by our own food makers

“Calories in, calories out,” he says, “is a completely disproven hypothesis.”

Hyman advocates a cold-turkey approach to his patients. “You want people to experience their hunger, their behavior, their mood, their energy [and] their chronic symptoms if they stop [consuming] sugar and starch for a week or two weeks or three weeks,

Our biochemistry, he says, not will power, drives our cravings and hunger patterns. It’s not a “moral failing that we can’t control our diet.”

Hyman advised me to add “a lot of fat, because fat makes you feel full [and] speeds your metabolism,

Fat actually helps you burn fat,” he explained, destroying many of the myths I’d grown up with

Fat, he says, “increases muscle mass and decreases inflammation — if it’s the right fat” — by that he includes coconut butter, MCT oil (or medium-chain triglycerides), extra-virgin cold-pressed olive oil, and those found in wild fatty fish such as salmon and sardines, nuts and avocados. (See his complete list at thechalkboardmag.com/dr-hyman-good-fat-bad-fat .)

here’s the part that blew my mind: I started to lose weight. Before the detox I weighed 166 pounds.

Twelve weeks later, I hit a new low adult weight: 155. I’ve cinched in my belt a notch. My bloodwork looks much better (my triglycerides dropped by half in six weeks

I’m now in my fourth month of a modified detox — I don’t want to live without wine or some sweets (I eat three 1-inch squared pieces of very dark chocolate a day). I know I can’t avoid all added sugars, no matter how vigilant I may be.

as with climate change, the powers that be in this country are doing very little to head off the potentially disastrous results of expanding obesity, obesity specialists say.

Well-intentioned efforts like limiting access to huge portions of sugar-sweetened soda, the scientists note, are effectively thwarted by well-heeled industrie

With rare exceptions, the sugar and beverage industries have blocked nearly every attempt to add an excise tax to sugar-sweetened beverages.

Claims that such a tax is regressive and unfairly targets low-income people is shortsighted

“What people would save in health care costs would dwarf the extra money paid as taxes on sugar-sweetened beverages,” he said in an interview.

in a city like Philadelphia, where a soda tax of 1.5 cents an ounce took effect three years ago, total purchases declined by 38 percent even after accounting for beverages people bought outside the city

piecemeal changes like this are not enough to make a significant difference in the obesity forecast for the country

nationwide changes are needed in the ubiquitous food environment that has fostered a steady climb toward a weight-and-health disaster.

Americans weren’t always this fat; since 1990, the prevalence of obesity in this country has doubled.

Our genetics haven’t changed in the last 30 years. Rather, what has changed is the environment in which our genes now function.

“Food is very cheap in the United States, and super easy to access,”

We eat out more, consuming more foods that are high in fat, sugar and salt, and our portion sizes are bigger.

“You don’t even have to leave home to eat restaurant-prepared food — just call and it will be delivered.

As a society, we also snack more, a habit that starts as soon as toddlers can feed themselves.

“People are snacking throughout the day,” Mr. Ward said. “Snacking is the normal thing to do in the United States. In France, you never see anyone eating on a bus.”

We also eat more highly processed foods, which have been shown to foster weight gain, thanks to their usually high levels of calories, sugar and fat.

even when controlling for weight, consuming lots of processed foods raises the risk of developing Type 2 diabetes.

“Through marketing, we’re constantly being sold on foods we didn’t even know we wanted. We’re all about immediate rewards. We’re not thinking about the future, which is why we’re going to see more than half the population obese in 10 years.”

Unless something is done to reverse this trend, Mr. Ward said, “Obesity will be the new normal in this country. We’re living in an obesogenic environment.”

“if I could wave a magic wand, I’d make a tax on beverages a federal mandate because they’re the largest source of added sugar in the diet and are strongly linked to weight gain and health problems.

the link between beverage consumption and greater intake of calories may also apply to drinks flavored with no-calorie or low-calorie sweeteners.

prompting restaurants to gradually, surreptitiously reduce the amount of fat, sugar and calories in the meals they serve could help put the brakes on societal weight gain. “Menus could make healthier, lower-calorie meals the default option,

Controlling portion sizes is another critically important step. “Big portions are especially motivating for low-income people who reasonably want to get more calories for their dollar,”

Another policy-based approach that could reverse rising obesity projections might be to partner with climate control advocates, Dr. Bleich suggested. “If we pull more meat out of the American diet, it would help both the environment and weight loss,

“prevention is the way to go. Children aren’t born obese, but we can already see excessive weight gain as early as age 2. Changes in the food environment are needed at every level — local, state and federal. It’s hard for individuals to voluntarily change their behavior.”

health-promoting changes in the food packages provided to low-income women, infants and children since 2009 have helped to reverse or stabilize obesity in the preschool children who receive them.

The campaign takes a distinctly different approach to campaigns in other countries, which have pushed to reduce sugar consumption.

The government has taken an interventionist approach, using subsidies to help sell Indian sugar overseas, an approach that has been opposed by other sugar-producing nations.

one particularly cherished aspect of our diet might not just be an unhealthful indulgence but actually be toxic, that when you bake your children a birthday cake or give them lemonade on a hot summer day, you may be doing them more harm than good, despite all the love that goes with it.

I’ve spent much of the last decade doing journalistic research on diet and chronic disease — some of the more contrarian findings, on dietary fat, appeared in this magazine —– and I have come to conclusions similar to Lustig’s.

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.

Sugar was a luxury in Europe prior to the 18th century. It became widely popular in the 18th century, then graduated to becoming a necessity in the 19th century.

Cruz hit Rubio on his support of the federal sugar program saying that Rubio can’t call himself a tea party member

Rubio has been a long supporter of sugar subsidies, which drive up the price of of sugar for American consumers. His support of sugar subsidies is believed to be because of his close relationship with Jose “Pepe Fanjul,” the Florida billionaire sugar mogul who has been a longtime donor to Rubio.

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?”

imilar increases occurred at the same time for girls in Canada for mood disorders and for self-harm. Girls in the U.K. also experienced very large increases in anxiety, depression, and self-harm (with much smaller increases for boys).

Some have argued that these increases reflect nothing more than Gen Z’s increased willingness to disclose their mental-health problems. But researchers have found corresponding increases in measurable behaviors such as suicide (for both sexes), and emergency-department admissions for self-harm (for girls only). From 2010 to 2014, rates of hospital admission for self-harm did not increase at all for women in their early 20s, or for boys or young men, but they doubled for girls ages 10 to 14.

The available evidence suggests that Facebook’s products have probably harmed millions of girls. If public officials want to make that case, it could go like this:

2. The timing points to social media.

National surveys of American high-school students show that only about 63 percent reported using a “social networking site” on a daily basis back in 2010.

But as smartphone ownership increased, access became easier and visits became more frequent. By 2014, 80 percent of high-school students said they used a social-media platform on a daily basis, and 24 percent said that they were online “almost constantly.”

from 2010 to 2014, high-school students moved much more of their lives onto social-media platforms.

Notably, girls became much heavier users of the new visually oriented platforms, primarily Instagram (which by 2013 had more than 100 million users), followed by Snapchat, Pinterest, and Tumblr.

Boys are glued to their screens as well, but they aren’t using social media as much; they spend far more time playing video games. When a boy steps away from the console, he does not spend the next few hours worrying about what other players are saying about him

Instagram, in contrast, can loom in a girl’s mind even when the app is not open, driving hours of obsessive thought, worry, and shame.

3. The victims point to Instagram.

In 2017, British researchers asked 1,500 teens to rate how each of the major social-media platforms affected them on certain well-being measures, including anxiety, loneliness, body image, and sleep. Instagram scored as the most harmful, followed by Snapchat and then Facebook.

Facebook’s own research, leaked by the whistleblower Frances Haugen, has a similar finding: “Teens blame Instagram for increases in the rate of anxiety and depression … This reaction was unprompted and consistent across all groups.” The researchers also noted that “social comparison is worse” on Instagram than on rival apps.

Snapchat’s filters “keep the focus on the face,” whereas Instagram “focuses heavily on the body and lifestyle.

A recent experiment confirmed these observations: Young women were randomly assigned to use Instagram, use Facebook, or play a simple video game for seven minutes. The researchers found that “those who used Instagram, but not Facebook, showed decreased body satisfaction, decreased positive affect, and increased negative affect.”

4. No other suspect is equally plausible.

Correlation does not prove causation, but nobody has yet found an alternative explanation for the massive, sudden, gendered, multinational deterioration of teen mental health during the period in question.

The subset of studies that allow researchers to isolate social media, and Instagram in particular, show a much stronger relationship with poor mental health. The same goes for those that zoom in on girls rather than all teens.

In a 2019 internal essay, Andrew Bosworth, a longtime company executive, wrote:While Facebook may not be nicotine I think it is probably like sugar. sugar is delicious and for most of us there is a special place for it in our lives. But like all things it benefits from moderation.

Bosworth was proposing what medical researchers call a “dose-response relationship.” Sugar, salt, alcohol, and many other substances that are dangerous in large doses are harmless in small ones.

his framing also implies that any health problems caused by social media result from the user’s lack of self-control. That’s exactly what Bosworth concluded: “Each of us must take responsibility for ourselves.” The dose-response frame also points to cheap solutions that pose no threat to its business model. The company can simply offer more tools to help Instagram and Facebook users limit their consumption.

social-media platforms are not like sugar. They don’t just affect the individuals who overindulge. Rather, when teens went from texting their close friends on flip phones in 2010 to posting carefully curated photographs and awaiting comments and likes by 2014, the change rewired everyone’s social life.

Improvements in technology generally help friends connect, but the move onto social-media platforms also made it easier—indeed, almost obligatory––for users to perform for one another.

Public performance is risky. Private conversation is far more playful. A bad joke or poorly chosen word among friends elicits groans, or perhaps a rebuke and a chance to apologize. Getting repeated feedback in a low-stakes environment is one of the main ways that play builds social skills, physical skills, and the ability to properly judge risk. Play also strengthens friendships.

When girls started spending hours each day on Instagram, they lost many of the benefits of play.

First, Congress should pass legislation compelling Facebook, Instagram, and all other social-media platforms to allow academic researchers access to their data. One such bill is the Platform Transparency and Accountability Act, proposed by the Stanford University researcher Nate Persily.

The wrong photo can lead to school-wide or even national infamy, cyberbullying from strangers, and a permanent scarlet letter

Performative social media also puts girls into a trap: Those who choose not to play the game are cut off from their classmates

Instagram and, more recently, TikTok have become wired into the way teens interact, much as the telephone became essential to past generations.

f those platforms. Without a proper control group, we can’t be certain that the experiment has been a catastrophic failure, but it probably has been. Until someone comes up with a more plausible explanation for what has happened to Gen Z girls, the most prudent course of action for regulators, legislators, and parents is to take steps to mitigate the harm.

(Boys lost less, and may even have gained, when they took up multiplayer fantasy games, especially those that put them into teams.)

Second, Congress should toughen the 1998 Children’s Online Privacy Protection Act. An early version of the legislation proposed 16 as the age at which children should legally be allowed to give away their data and their privacy.

Unfortunately, e-commerce companies lobbied successfully to have the age of “internet adulthood” set instead at 13. Now, more than two decades later, today’s 13-year-olds are not doing well. Federal law is outdated and inadequate. The age should be raised. More power should be given to parents, less to companies.

Third, while Americans wait for lawmakers to act, parents can work with local schools to establish a norm: Delay entry to Instagram and other social platforms until high school.

Right now, families are trapped. I have heard many parents say that they don’t want their children on Instagram, but they allow them to lie about their age and open accounts because, well, that’s what everyone else has done.

certainly, Democrats must turn to the courts when the rule of law is broken. But they have to be for something, as well — a master policy narrative, promoting things that help average Americans. The old Broadway adage was how it will play in Peoria. For Democrats, they should think of Joe Biden’s Scranton, Pa., every time they take to a podium.

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

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

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.

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.

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

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

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

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 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.

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 safest course is to avoid them altogether

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

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.

One area is freeing itself from US hegemony and is thriving, but may founder if Chinese and Indian growth slows. Another is increasingly integrated with the US and Canada. Despite its current travails, it will discover a path to prosperity when the US does.

The initial report presents a flexible daily diet for all food groups based on the best health science, which also limits the impact of food production on the planet

The Eat-Lancet report posits that the global food system is broken. From the numbers quoted alone, it is hard to disagree: more than 2 billion people are micronutrient deficient, and almost 1 billion go hungry, while 2.1 billion adults are overweight or obese

Unhealthy diets are, it says, “the largest global burden of disease”, and pose a greater risk to morbidity and mortality than “unsafe sex, alcohol, drug, and tobacco use combined”

we are not (yet) extinct, but we have an era named after us. And what we are eating has a lot to do with that. Food production, the report states, “is the largest source of environmental degradation”.

It has identified a daily win-win diet – good for health, good for the environment – that is loosely based on the much-lauded Mediterranean diet, but with fewer eggs, less meat and fish, and next to no sugar.

it does include a range of foodstuff types that are adaptable, in theory, to the cuisines (potato or cassava; palm-oil-based, say, or soy-rich) and primary dietary restrictions (omnivore, no pork, pescatarian, vegetarian, vegan) found across the world

the daily ration of red meat stands at 7g (with an allowable range of 0-14g); unless you are creative enough to make a small steak feed two football sides and their subs, you will only be eating one once a month.

you are allocated little more than two chicken breast fillets and three eggs every fortnight and two tins of tuna or 1.5 salmon fillets a week

Per day, you get 250g of full-fat milk products (milk, butter, yoghurt, cheese): the average splash of milk in not very milky tea is 30g

The diet functions on the basis of 2,500 kcal daily,

It is still more food – way, way more – than two billion people currently have access to.

The future served up on a plate Monday

Breakfast: Porridge (made with water) with 1 tbsp honey or maple syrup, topped with nuts and seeds, and one piece of fruit; one cup of tea or coffee with milk

Lunch: Fennel, avocado, spinach and broccoli salad with feta and mustard and plant-oil dressing with one slice of sourdough bread, plus one plain yoghurt pot with a handful of berries

Dinner: Roast red cabbage and red lentil dahl with rice

Snack: Sugar-free ricecakes with nut butter.

Tuesday Breakfast: Two eggs with two slices wholemeal toast and Marmite

Lunch: Barley or other wholegrain salad with smoked mackerel, seeds

radishes, celery, chickpeas, herbs, oil and lemon juice dressing; one piece of fruit.

Dinner: One baked sweet potato with salsa, cavolo nero, avocado, black beans, grated cheese and a dollop of sour cream.

Snack: One handful of roasted chickpeas.

Wednesday Breakfast: Two slices of wholemeal toast with one sliced banana and honey; one cup of tea or coffee with milk.

Lunch: Spicy miso noodle soup with tofu, radishes, leafy greens and poached egg (that’s your quota for two weeks used up: no eggs for you next week); small pot of plain yoghurt

Dinner: Steamed veg (kale, broccoli and carrot) with a yoghurt and fresh herb dressing and olive oil, root veg and bean mash.

Snack: Cannellini bean dip with red pepper sticks