RFK Jr. Pushes Simple Nutrition, Berkeley Expert Reflects

With Robert F. Kennedy, Jr.'s appointment as Secretary of Health and Human Services under the second Trump administration, a new "Make America Healthy Again" (MAHA) agenda proposes to radically simplify nutritional guidelines, with news outlets reporting since the spring that a new guideline may be 4 pages long (as opposed to over 160) and stress that Americans should "eat whole food." This comes as Trump recently announced reviving the presidential fitness test, which the Obama administration had retired, in another move to return Americans to a seemingly simpler time.

In a recent Annual Review of Nutrition article, Kevin Klatt, an assistant research scientist and instructor in the Department of Nutrition Sciences and Toxicology at UC Berkeley, delves into the history of nutrition science and the Dietary Guidelines for Americans, exploring how pressures to establish authoritative government nutritional guidelines coexisted with ongoing - and unresolved - debates among nutritional scientists and epidemiologists about how dietary intake correlates to chronic disease and obesity.

First established in 1980, the Dietary Guidelines for Americans harnessed nutritional science as it existed at the time into public-facing guidelines for how Americans should eat. In his review of this history, Klatt points to two bellwether moments - President Eisenhower's fatal heart attack in 1955 and a 1961 Time Magazine cover warning of the dangers of fat intake and heart disease - that alerted Americans to the prevalence of cardiovascular disease as a new threat facing Americans, as the risk of death from infectious disease waned.

Since the early 2000s, as obesity rates continued to increase, the American public witnessed the pendulum swing as experts presented different theories of the connection between dietary intake and chronic disease. Public trust in nutritional health authorities eroded as high-profile exposés questioned long-established truths. Many will remember the widely-circulated food pyramid with whole grain carbohydrates at its base, posted seemingly ubiquitously in the 1980s and 1990s; the USDA now features a circle, or MyPlate, to represent a balanced diet.

As RFK Jr. stands poised to introduce a new phase in US dietary guidelines, UC Berkeley News spoke with Klatt to discuss the history of nutritional science guidelines in the U.S. and what the future might hold in the wake of MAHA, along with how cutting-edge developments in pharmacology are reshaping the field.

Your article takes us through a history of dietary guidelines in the U.S., and you conclude that establishing - or maybe reestablishing - public trust in nutritional guidelines would require a massive overhaul in funding priorities and a commitment not previously seen in the U.S. Do you see this as likely in the near future?

I think it's unlikely we'll see a massive investment in nutrition research funding that would improve the evidence that supports the guidelines, because we are cutting National Institute of Health funding quite massively. There have been some calls to push a nutrition science agenda aimed at producing data relevant to regulators, but nothing specific on investing in very large randomized control trials, or even smaller trials related to how things like food processing impacts chronic disease risk factors. The current administration's actions have actually led to the loss of the top nutrition scientist studying the issue of "ultraprocessed foods." I would say the current administration is overwhelmingly going in the opposite direction of what we would need to do to improve the quality of evidence informing dietary guidance and identify new mechanisms that underlie how foods impact the risk of obesity and chronic disease.

RFK Jr. has stated publicly that the next Dietary Guidelines for Americans will be a much shorter document that can be digested by the public. Is this a smart move?

This is a bit of a misunderstanding of the role of the Dietary Guidelines. The title indicates they are "for Americans" but the user is not actually intended to be the American public. Early editions of the dietary guidelines in the 1980s had maybe seven bullet points that were a bit more public facing, but since 2005, the dietary guidelines have really been intended to be used by healthcare professionals and as a policy document. The current administration seems to want to roll that back, and doesn't seem to acknowledge that it's a policy document.

If it's a policy document, who is it addressing?

It's a policy document from the federal government, and that's really where it has some fangs in that it can be used to inform federal programs. That can be everything from the Supplemental Nutrition Assistance Program (SNAP) to the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). It guides the school lunch program and the military. It's invoked in various ways across labeling initiatives and across all these various federal initiatives and policy guidance.

The 160 pages is not intended for the everyday American to sit down and wade through it. It is supposed to be a scientifically rigorous document, so that when you tell the school lunch program you can't serve whole milk, you have to buy 1% or 2% or skim, there is a scientific document that backs up that rationale. Anybody who wants to fight that - be it a congressman who is in a state that produces lots of dairy or the dairy industry or specific food product manufacturers - they have to go up against that policy document and the science within it.

If this 160 page document is speaking to these programs like the military, WIC and SNAP, and it gets replaced by a four page document, where does that leave those programs?

I think it'll be a period of chaos where federal programs and policies that are supposed to be based on the very specific details in the Dietary Guidelines will suddenly no longer be in line with the document. I suspect the administration will probably have to grandfather in previous recommendations and then just have this four-page document serve as a solely public facing document. The Dietary Guidelines drive industry formulations; I think there will be a period of deep uncertainty if we just get a four pager.

RFK Jr.'s proposed guidelines place a special emphasis on ultraprocessed foods or UPF, reflecting his general emphasis on dangers posed by chemical processing. Do you think this focus has promising implications for the near future?

Not particularly. They've used the term without defining it, and they've made up new terms like ultraprocessed fats and ultraprocessed grains that are not found within the scientific literature. In the administration's recently released childhood chronic disease report, they just made up terms about it. There's an official four-stage categorization system for processing that is used a lot in the literature called the NOVA classification: the most processed form is the ultraprocessed, and they use that sometimes, but then they seem to go rogue and never clearly say what they mean.

We learned in the era of recommending low fat diets that what you replace foods with matters - replacing fat with starch and sugar was not helpful for obesity or cardiovascular risk. With focusing on UPF, we have to ask whether efforts to make them not "ultraprocessed" by removing "industrialized" ingredients will actually make them more health promoting. There is a concern with the demonization of all industrial ingredients that our food won't have helpful additives that have preservative and anti-microbial properties - if you have to throw out your loaf of whole grain bread quicker because it's going bad a lot faster, that's not a good thing for people who are strapped on a budget.

In that case, do you think that the forthcoming guidelines will likely only further increase American public confusion and mistrust over dietary guidelines?

I would imagine so. There's this assumption that it's just a knowledge deficit that is stopping Americans from eating healthfully. If you look at every nutrition education campaign that's ever happened, there's limited long-term penetration because they don't change the fact that in our food environment the default, easy to obtain option is the thing that is the inverse of our dietary guidelines. It's not like you walk out into your food environment and it's easy to make half of your plate fruits and vegetables, or to get whole grains and lean proteins.

It's convenient for the administration to think that if people only knew more about healthy eating, they'd be healthier. If you start to acknowledge the reality of all the things that have changed about our food system over the past century, that add up to likely why we have a major obesity and chronic disease epidemic, it would require pulling a lot of policy levers, picking economic winners and losers across the food system, and potentially legislating to really change how foods are formulated, advertised, marketed, and how available they are. Those are, I think, political losses for pretty much any administration. Michelle Obama tried to do a little bit, just getting sodium down in school lunch, and she got labeled the food police by every conservative media outlet.

Do you think it's even possible to have clarity around dietary guidelines for the public?

At this point in time, I don't really think so. We live in a media ecosystem where people profit substantially off providing contrarian dietary advice. I mean, you have influencers confidently pushing everything from low fat vegan diets to high fat carnivore diets and everything in between as cure-alls. We are at the point where trust and expertise are so degraded that I don't know that anything is going to change in the public perception that nutrition scientists just don't know much.

I think a well done campaign by the government to get really engaged and be in the social media spaces where people are getting their information from and talk transparently about what we know and don't know could start to build back trust in some. But from what I've seen from the administration and people associated with it, they are actively relying on the public's distrust of public health. And they are now the health authorities.

How do you see the future of nutritional sciences unfolding in conversation with what's happening in the pharmaceutical industry with breakthroughs around obesity treatment?

I think what GLP-1 receptor agonists like Ozempic tell us, in addition to genetic epidemiology, is that almost everything about obesity localizes to the brain. That framework - you have to target the brain and regulate things around the brain's dominant control of energy balance in the body - has only more recently broken through in the nutrition space. Right now, there's a lot of focus in the dietary guidelines on foods and nutrients and not on the sort of "sensory science" factors that interact with brains and psychology - things like food texture, energy density, or palatability. Whereas we have quantitative numbers for nutrients, we have nothing quantitative for factors that drive food intake behavior.

This new paradigm, where you can just take a drug and live in this food environment that is promoting obesity for most people and you can activate a single receptor in the brain and suddenly block out all of that and lose a significant amount of weight and maintain it, assuming you keep taking this drug, is a pretty significant finding.

Do you think that the implication eventually could be that nutrition science doesn't matter as much?

I think that's a reality that scares a lot of people who are nutrition advocates. Nutrition will always be important because you always need to eat food. But if we as a society want to think about changing the food system and the food environment, I think we have to start studying everything in our food environment and how these interact with our brain, driving that desire to eat. And I'd note, this can become fatphobic and dystopian - as in, you should never get pleasure from any food - and I don't think that is the argument, but really dissecting, how have we engineered foods?

If I could allocate a bunch of research money, it would be to build centers where you put the best neuroscientists, nutrition people, and food scientists, and ask, how have we changed food in a way that promotes the likelihood of what we call hyperphagia, or overeating beyond the physiological requirement? The impetus of the UPF people is this assumption that if you just ate completely whole foods that you would cure all the nutrition problems. But I think there's potential for more of a technofuturist type approach that would say we've just engineered foods in the wrong ways.