Abstract
As much as the field of health promotion has benefited mightily in the past decades from Internet abetted access to unlimited health content, our field is also experiencing the best of times and the worst of times. When it comes to our core work of supporting healthy decision-making for individuals, organizations, and communities, the unfettered, voluminous material available has, unimaginably, made facts seem fickle. I am delighted to have Dr Marion Nestle’s insights as a preamble to this special issue of the journal. Educating about nutrition and food choices, in particular, has become as much a contest between competing interests and commercial forces, as it has been a discipline guided by credible professionals. I am all in on our Constitution’s First Amendment, and having live abroad, I am endlessly smitten with America’s robust expression and freedom of speech. But I wonder if our forefathers had seen the Internet coming whether they might have added more stipulations about telling the truth. This special issue of the American Journal of Health Promotion is dedicated to nutrition research where new discoveries, and impassioned scientists like Dr Nestle, provide the light needed to grow fresh knowledge. Exposing both academics and the public to well-done studies about how food choices are influenced is ever more crucial in an era of alternative facts about what constitutes healthy eating.
In one of the most memorable first sentences of a historic novel, Charles Dickens prepared readers for his story about the French Revolution by writing, “It was the best of times, it was the worst of times.” Literary scholars have reflected on his flair for developing themes of good and evil, often couched in his adroit allusions to darkness and light and framed by a setting in Paris and London. Casual readers may foremost remember the characters from “A Tale of Two Cities,” given their impertinent foolishness and unforetold acts of redemption. But serious readers of that time were debating Dickens’ comparisons between the French and the British aristocracies. How could British leaders avoid the oppressive “rapacious license” he cautioned was evermore a defining attribute of Paris’s wealthiest classes? 1
Americans today are in the midst of an information revolution. As much as the field of health promotion has benefited mightily in the past decades from Internet abetted access to unlimited health content, our field is also experiencing the best of times and the worst of times. When it comes to our core work of supporting healthy decision-making for individuals, organizations, and communities, the unfettered, voluminous material available has, unimaginably, made facts seem fickle. Educating about nutrition and food choices, in particular, has become as much a contest between competing interests and commercial forces, as it has been a discipline guided by credible professionals. The second line in Dicken’s opening sentence is less famous but perhaps more pertinent to our time: “it was the age of wisdom, it was the age of foolishness.” Given the pervasiveness of food marketers, social media, and diet charlatans, separating the wicked from the wise is a dickens of a problem.
2017 Papers of the Year
The antidote to the shadowy disinformation cast by countless wellness pundits is credible science, and to this end, I was pleased to feature our top researchers of the year for 2017. 2 Along with my associate editors, we recognized 8 excellent papers from 2017. Special congratulations go out to Juned Siddique, Peter John de Chavez, Lynette L. Craft, Patty Freedson, and Bonnie Spring who won the “Michael P. O’Donnell Paper of the Year Award” for their study on “The Effect of Changes in Physical Activity on Sedentary Behavior: Results from a Randomized Lifestyle Intervention Trial.” 3 The “Editor in Chief’s: Paper of the Year for 2017” went to “Rx: It’s Good to be Good” authored by Stephen Post and accompanied by a commentary by Sarah Johnson who is coeditor of “The Art of Health Promotion” section of this journal. 4
An Interview With Marion Nestle
This special issue of the American Journal of Health Promotion is dedicated to nutrition research, where discoveries provide the light needed to grow fresh knowledge. Exposing both academics and the public to well-done studies about how food choices are influenced is ever more crucial in an era of alternative facts about what constitutes healthy eating. Besides celebrating scientists, another way I cope with the dark side of social media is to interview and profile health promotion’s most fecund and authoritative leaders. It is uncommon to find credible scholars who also command attention in the public square given that being a nerd and being a celebrity don’t usually mix. It is rarer still for an academic to use their expert clout to enter the food politics mêlée while at the same time enlightening the masses. I have described Marion Nestle as one of my public health heroes, so I wasn’t surprised, in reviewing Nestle’s biography, that the School of Public Health at the University of California, Berkeley, has formally christened her such. Two other prolific authors, whom foodies also read faithfully, covet Nestle and her work. Mark Bittman ranked her #1 in “foodies to be thankful for,” and she was ranked #2 in Michael Pollan’s list of powerful foodies in deference to his politically savvy number one pick: Michelle Obama.
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The big challenges in nutrition these days are political—dealing with food insecurity on the one hand, and obesity and its consequences on the other.
I am all in on our Constitution’s First Amendment, and having live abroad, I am endlessly smitten with America’s robust expression and freedom of speech. But I wonder if our forefathers had seen the Internet coming whether they might have added more stipulations about telling the truth. It seems the courts have been clear that erroneous speech is protected speech, and no exceptions are likely “for any test of truth.” 9 In other words, inept bloggers and ambitious marketers can spew away about food properties and benefits, secure in their not ever needing to bear the burden of proof. Perhaps the framers of our nation’s rules had Marion Nestle in mind when they allowed that we shouldn’t use “fighting words and other threats to the peace.” Nestle blogs nearly every day, and there is seldom a shadowy development in food politics that Nestle doesn’t expose as a threat to humanity. 10 I know I feel more secure in knowing that she’ll shine a light on issues that many powerful others wish we didn’t see.
Marion Nestle
(Photo by Bill Hayes)
Describe what attracted you to nutrition research and advocacy and particularly food politics.
I was well along in my first teaching position in the Biology Department at Brandeis University when I was handed a nutrition course to teach. As I like to put it, it was like falling in love. From the first day I started working on my first nutrition course, I was enthralled by the uncertainty of nutrition science and the challenge of developing public policy based on research that could only be observational; you can’t put humans in cages and feed them defined diets for 40 or 50 years. It was immediately obvious that nutrition is a splendid entry point into basic human physiology as well as into some of society’s most important—and vexing—economic, political, and environmental problems. Beginning students had a hard time reading papers in Cell or the Journal of Molecular Biology but could immediately see the flaws in experiments published in nutrition journals.
As I said, this was like falling in love and I never looked back. My next job was teaching nutrition to medical students at University of California, San Francisco and the one after that was as senior nutrition policy advisory to the federal Office of Disease Prevention and Health Promotion in Washington, DC—in the Reagan Administration, no less. By that time, I was thoroughly hooked on the intellectual challenges of a field that combined science, politics, and human behavior along with food production and the preparation of delicious meals.
We know what constitutes a healthy diet, something so simple that the food writer Michael Pollan can put it in 7 words: Eat food. Not too much. Mostly plants. Most of the arguments about what to eat—fat versus carbohydrate, for example—focus on single nutrients taken out of their caloric context. We don’t eat single nutrients or even single foods; we eat diets of extraordinary variety and complexity. Many quite different dietary patterns support optimal health and longevity, but all the good ones balance calorie intake with caloric output and include plenty of vegetables.
I’m impressed by how many focus on sugar-sweetened beverages. As the author of a book on the topic—Soda Politics: Taking on Big Soda (and Winning)—I understand their fascination. They are sugars and water and have no redeeming nutritional value, which makes them an easy target. Everyone would be healthier drinking less of them. The big challenges in nutrition these days are political—dealing with food insecurity on the one hand and obesity and its consequences on the other. If we want people to eat more healthfully, we have to take on our current agricultural system and the food industry, both aimed at getting us to eat as much as possible of highly caloric cheap foods.
We produce plenty of food, so the big questions are how to get adequate food to people who need it, create a food environment that fosters heathier food choices, and develop agricultural production systems that promote health and sustainability. I’d like to see much closer linkages between agriculture, health, and environmental policy.
My forthcoming book, Unsavory Truth: How Food Companies Skew the Science of What We Eat (Basic Books, October 2018) is about food industry funding of nutrition research and practice, so I’m deeply immersed in that area right now. I’d like to see nutrition researchers and practitioners become more aware of the risks of industry funding—in biased research results and real and apparent conflicts of interest—take these risks more seriously and do a lot more to try to prevent and mitigate them. As professionals, I would hope that nutritionists would become deeply engaged in efforts to produce food more sustainably, distribute it more fairly, and make sure that it is marketed more ethically.
Oh, you want me to do the work? I don’t usually interview myself, but I suppose if I did I would want to know how I stay optimistic about food issues in the light of current politics. That’s easy. I teach students who care about food issues and who inspire me every day. What happens to food systems depends on them. They are demanding healthier and more sustainable food production, distribution, and consumption. Food companies are already responding to those demands. As the food movement grows and gets stronger, I think we will see lots of positive changes.
The Antidote for Fake Nutrition News
In the nascent era of the worldwide web, I was blithely enthusiastic and joined those who only touted the presumed pluses of the democratization of information. Everyone can and should have a voice! We would be liberated from those lefty journalists and all that pesky source checking and from those highbrow academics with their haughty jargon. Today, with bloggers using megaphones and news funneled through echo chambers, I’m yearning for a noise-canceling headset and more prudent access to, and dissemination of, information. “Intelligence Squared” hosted a provocative debate on the proposition: “Is Smart Technology making us Dumb?” 11 It was the first time, after over 100 of their invariably brilliant debates, that audience voting about who won ended in a tie.
Listeners were apparently torn between information onslaughts that could mindlessly, sometimes addictively, suck us in versus the promise that technology can free us for higher pursuits. The debaters arguing for the proposition focused on the irony of a medium that, instead of broadening our thinking, only scratches us when and where we feel an intellectual itch. The debaters against the proposition believed in activated consumerism and a world where the internet will enable breakthroughs in knowledge, not just easily accessible information. Are we getting dumber about nutrition? The most egregious contemporary form of the Dickensian “rapacious license” is that of bloggers with science backgrounds and an axe to grind. They cherry pick the literature incessantly, desperate to attract eyeballs that share their myopic vision. Credible scientists do the opposite. Read the limitations and discussion sections in these journal pages to be reminded how readily serious researchers acknowledge findings dissimilar to theirs and share reasons for why their study results could not have likely captured the whole truth.
Bitcoin followers believe a return to the original open access attributes of the web is afoot and that this will enable individuals to retake control information and, ultimately, their autonomy.
For a challenging technical point of view on why the best of times may still be ahead in this information age, you may want to study up on the bitcoin. If you are like me, you really don’t know the difference between a bitcoin and an arcade token. But if you read journalist Steven Johnson’s smartly researched article, “Beyond the Bitcoin Bubble,” you’ll learn that the 2 are metaphorically similar. What’s more, bitcoins may have less to do with an obscure monetary market and more to do with disrupting the hegemonic companies that control so much of today’s winner-takes-all approach to information ownership. 13 Dickens’ allusions to darkness and light when he wrote about the revolution of his time offered him a way to speak truth to power. He felt too much control had been ceded to too few, and they exploited it greedily. Dickens famously predicted that those in control would reap what they sowed. Bitcoin followers believe a return to the original open-access attributes of the web is afoot and that this will enable individuals to retake control of their identities, their information, and, ultimately, their autonomy. Nestle and THI and the scientists on these pages are busy sowing seeds to enable an age of wisdom. We honor them by following their work and turning off those who peddle foolishness. When the foolish get too loud to ignore, as Nestle has shown us, we shouldn’t hesitate to give them the dickens.