MAHA, Nutrition, and the FDA

Among the more interesting developments in the recent election was the emergency of Robert Kennedy as a prominent figure in the MAGA movement – and the collateral emergence of the MAHA movement (Make America Healthy Again). As crisply laid out in short YouTube video, MAHA aims to transform public health by zeroing in on “our nation’s biggest health challenge – chronic disease.”  The first order of business will be to “clean up the public health agencies like CDC, NIH, FDA, and the U.S. Department of Agriculture,” which “have become sock puppets for the industries that they’re supposed to regulate.”

Undoubtedly, the public health and economic toll of chronic disease is staggering. As reported in a recent publication (citations omitted):

An estimated 129 million people in the US have at least 1 major chronic disease (eg, heart disease, cancer, diabetes, obesity, hypertension) as defined by the US Department of Health and Human Services. Five of the top 10 leading causes of death in the US are, or are strongly associated with, preventable and treatable chronic diseases. Over the past 2 decades prevalence has increased steadily, and this trend is expected to continue. An increasing proportion of people in America are dealing with multiple chronic conditions; 42% have 2 or more, and 12% have at least 5. Besides the personal impact, chronic disease has a substantial effect on the US health care system. About 90% of the annual $4.1 trillion health care expenditure is attributed to managing and treating chronic diseases and mental health conditions.

Moreover – and as recognized by FDA’s current commissioner Dr. Califf – several chronic diseases are diet-related. Nonetheless, the medical products sector historically has drawn the lion’s share of attention at FDA, with the agency’s leadership ranks reflecting that priority.

To be sure, there have been nutrition-related initiatives at FDA that target chronic disease. Back near the birth of this century, yours truly sat in on meetings of the agency’s Working Group on Obesity, which ultimately generated a report with a number of recommendations. Whatever the worth of those recommendations may have been, the fact is that the prevalence of obesity has significantly increased in the intervening years. More recently, the agency invested significant efforts in modernizing nutrition labeling requirements and implementing a sodium reduction initiative. However, it’s fair to say that FDA’s food program has focused primarily on implementation of the many mandates in the Food Safety Modernization Act of 2011. With the bulk of that work complete, the program might have more bandwidth for a renewed push at nutrition-related initiatives through the newly established Nutrition Center of Excellence – which brings us back to MAHA.

The Wall Street Journal reports that Mr. Kennedy favors Dr. Casey Means for the role of surgeon general or FDA Commissioner. As a physician trained at Stanford, Dr. Means would fit the mold of a typical FDA commissioner – but the similarities may end there. Dr. Means seems to be laser focused on the root causes of chronic disease, including the role of diet in metabolic health – and she has taken FDA to task for “not adequately protecting us from toxic food.” How much of that critique could be translated into an effective regulatory (or deregulatory) agenda in light of constraints on FDA’s authority and other factors will be the subject of another blog posting, but the power of the bully pulpit should not be underestimated. It also bears mention that much of the MAHA agenda could unfold through USDA, which administers the Supplemental Nutrition Assistance Program (SNAP) and the National School Lunch Program – two food and nutrition assistance programs that directly affect the diets of tens of millions of consumers every day.

Regardless of who ultimately sits in the FDA Commissioner’s seat, MAHA can be expected to have a seat at the table – and those who ignore the emergence of this movement and its priorities may be doing so at their peril.