STAT reviewed dozens of studies, interviewed chronic disease experts, and landed on three focus areas for RFK Jr. to boost health
Excerpt – Among Kennedy’s primary focuses so far has been convincing food companies to remove chemical additives and artificial dyes: an admirable goal, many nutrition experts say, but not the kind of change that would substantially improve people’s health when compared to other needed reforms. He will need to go bigger, they told STAT.
However, some researchers say Kennedy is right to keep his eyes on the environment Americans inhabit — the products in their supermarkets, the toxins in their homes, the health of their schools. It’s widely believed that altering behaviors person by person is less effective at improving health than targeting root causes that are driving down whole communities’ health. [..]
Here are three tactics experts and evidence point to as ones that could actually make a dent in the nation’s chronic disease epidemic:
Tactic 1. Go all out on metabolic disorders
RFK Jr. already has people in his corner with this take. Surgeon general nominee Casey Means and her brother, Kennedy adviser Calley Means, have called out metabolic disease as a key underlying issue in the U.S. These conditions — namely obesity, diabetes, and hypertension — increase people’s risk of developing other diseases, and are being diagnosed in younger populations. They are a big-ticket trio, and projected to keep increasing in coming years, driving up health care costs and causing great harm.
Diabetes, obesity, and hypertension often occur simultaneously because they share similar risk factors. That’s an opportunity for the new administration, experts say. Often, poor health is a result of mundane behaviors repeated over and over again: sitting too much and sleeping too little, eating lots of highly processed foods and few fruits and vegetables, drinking in excess or smoking at all.
Making even small changes in these key patterns — what’s sometimes called “behavior clustering” — could have big effects on health across the population. If everyone in a community walked 10 more minutes or ate a couple more fruits and vegetables each day, research suggests that could drive sizable improvements in chronic disease rates. [..]
For those with prediabetes, preventing the transition to insulin dependence is key. Federal officials can look to the national Diabetes Prevention Program [DPP] for proof. The program, covered under Medicare Part B, links beneficiaries with prediabetes to a lifestyle coach and peer support group, and helps them eat healthier, become more physically active, and lose weight over the course of one or two years.
Studies found participants lost up to 10% of their body weight with the program and in doing so, lowered their risk of diabetes by nearly 60% compared to a control group. (NIH cut funding to studies of the Diabetes Prevention Program in March, a move many diabetes researchers decried as short-sighted.)
“It’s not very heavily used,” said Kenneth Thorpe, chairman of the Partnership to Fight Chronic Disease. That’s in part because the DPP only became a covered benefit in 2018, shortly before the pandemic, and was mostly held in person. HHS could double down on the effort now. “That’s a program that works,” said Thorpe, who said he helped convince HHS to make the program a covered benefit.
For people with existing diseases, a slightly healthier lifestyle could keep them from developing still more costly conditions. If employers began using something like the diabetes program, “the population coming into the Medicare program are going to be much, much healthier,” said Thorpe, who co-directs the Emory Center on Health Outcomes and Quality. [..]
Tactic 2. Keep medications and vaccines as tools
[..] Death rates were slashed in half over the last century. The successful campaign against smoking is a major reason for that improvement, but so are medical advances and low-cost medications to keep hypertension and cholesterol in check. With more people developing hypertension and other heart disease risk factors at a younger age, public health can’t afford to undermine a cheap, widely available method for preventing hospitalization, severe disease and death. [..]
Kennedy should likewise embrace vaccines like those for hepatitis B, measles, and human papillomavirus, experts told STAT. Infections can lead to lifelong problems, like cognitive impairments, mobility issues, or liver damage. For example, mounting evidence suggests HPV infection may increase the risk of cardiovascular disease, and that vaccination could protect against it.
Tactic 3. Leverage federal powers to make healthier environments
[..] Kennedy is driving a national conversation about what’s on supermarket shelves, and trying to force the hand of major food companies and industry groups by moving public sentiment. But there are still other steps he could take, experts say. He could encourage states to incentivize healthy purchases, like produce, whole grains and nut butters, using SNAP dollars. However, a proposal in Congress could cut state funding for SNAP and further restrict use of the program.
He could take a hint from a handful of U.S. cities and Latin American countries and push for a tax on sugar-sweetened beverages at the national level. “This is a category of food that just brings zero benefit, it’s making us sick, we know people overconsume them. I think it’s a very reasonable place to start,” said Christina Roberto, associate professor of health policy at the University of Pennsylvania Perelman School of Medicine. [..]
A similarly effective but politically riskier health tax? On alcohol. Increasing federal taxes on alcoholic beverages could drive down consumption — and reduce the risk of many alcohol-related diseases — while generating revenue the government could use on other projects. Kennedy, although in recovery and sober, has not said much about alcohol use as a preventable driver of disease.
Through the Food and Drug Administration, his team could also lower sodium in the food supply. The FDA currently has voluntary sodium targets for food producers, but progress has been relatively slow-moving, experts say. HHS could make those targets mandatory, said Roberto, who directs the Psychology of Eating and Consumer Health lab. “To me, this is the biggest no-brainer food policy.”
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