Back when I was a kid, two of my two favorite food items were Coca-Cola and soft ice cream. I spent hot summer evenings standing on long lines at the local Carvel, waiting for my coveted cola float. It took me many years to kick my addiction to soft ice cream and to transition my craving for soda to sparkling water, which delivered the bubbles my palate was expecting without the sugar and food coloring.
This addiction took a long time to develop and an even longer time to overcome, which is one of the reasons I am so sympathetic to Health and Human Services Secretary Robert F. Kennedy Jr.’s announcement that the $113 billion Supplemental Nutrition Assistance Program benefits should not be used to purchase candy and soda. There is also the Healthy SNAP Act, reintroduced by Republicans to Congress in advance of Kennedy taking the reins at HHS, which would exclude soft drinks, candy, ice cream, and prepared desserts from being purchased by SNAP benefits. Arizona, Idaho, Kansas, Tennessee, and Utah have followed suit by introducing bills asking the federal government to bar junk food items from SNAP.
But the devil, as always, is in the details. It’s is important to ask: If SNAP can’t pay for junk food, what will people eat?
We must keep in mind that simply replacing bad foods with good is a lot like going cold turkey with any addiction, from alcohol to smoking to opioids. It rarely works. In fact, sugar addiction is very similar to opioid addiction in that both work on opiate receptors in the brain, but at least with opioids we have effective transition medications including buprenorphine and methadone, and for fast food addiction we have nothing. Sparkling water worked for me, but certainly isn’t a cure.
Another problem besides taste addiction: cost.
While produce is certainly healthier than candy or junk food, it is also far more expensive, which is a big problem especially in socioeconomically disadvantaged areas.
One solution to this would be direct federal subsidies to pay for healthy vegetables and salads as substitutes, while restricting SNAP choices at the same time.
But we would still have the problem of subsidizing food that no one wants to eat. And there are big financial incentives to keep the unhealthy food we have. When it comes to opioid addiction, drug lords are guarding their investment by keeping as many people hooked as possible, and when it comes to ultra-processed foods, both the food and the health insurance industries benefit from our bad health and obesity.
Any attempt at real reform must use a scalpel rather than a hatchet. The Kansas bill, for example, allows Kit Kats and Twix bars because they contain flour, while the proposed Arizona bill restricts granola bars but not potato chips. Inherent contradictions like these, along with no subsidies or programs to introduce healthy, yet somehow tasty alternatives, feel more political than practical. In Utah, a pending bill would provide free school lunches because the cost of grocery bills has gotten so high. But critics of the bill say that it doesn’t provide enough oversight of exactly what food would be offered.
Indeed, consider that some of the same politicians who opposed SNAP reform in the past are now backing it because the political climate has shifted in the opposite direction.
As much as Kennedy’s approach has a new feel to it, we have encountered the same type of solutions with the same accompanying problems before. Many Republicans were against the Healthy, Hunger-Free Kids Act of 2010, promoted by First Lady Michelle Obama, which authorized $4.5 billion in funding for healthy lunches in schools. A study published in Health Affairs in 2020 looked at more than 170,000 children over 15 years and revealed that this program decreased obesity for 5.9 million children living in poverty. Another study published in JAMA from the University of Washington School of Public Health in 2020 confirmed the positive effect on diet.
But critics of the program said that it was too expensive and introduced tasteless foods that kids still wouldn’t eat, and ultimately Trump rolled back some of the rules.
And then during the disarray and closures of the pandemic, the quality of food in schools gradually worsened, and it hasn’t gone back. Currently, more than 20% of American children are obese, a number that has tripled over the past 30 years,
and as Kennedy says, obesity is tied directly to chronic diseases, including diabetes, high blood pressure, and attention deficit hyperactivity disorder.
Kennedy has vowed to get ultra-processed food out of school lunches quickly. Whether he succeeds and to what extent remains to be seen especially given the ongoing addiction to (relatively) tasty bad food like rubbery pizza and French fries. The National School Lunch Program serves close to 30 million students per day. Replacement foods must be carefully designed to match the quality, texture, and taste of the unhealthy foods they are replacing. Some examples are broiled and baked food instead of fried, zucchini pasta, whole grains, crispy cauliflower instead of fries, fresh fruit and olive oil instead of butter. It is worth pointing out that one of the major criticisms of the Obama efforts focused on the fact that the replacement food didn’t taste good enough.
During the Covid pandemic, many public health pronouncements and advisories and mandates failed, precisely because they used the hatchet rather than the scalpel and weren’t specifically tailored to real public scenarios. We can’t afford another mistake like this especially in our underserved areas.
Marc Siegel is a professor of medicine and medical director of “Doctor Radio” at NYU Langone Health.
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