Poor Nutrition is Solvable

that today we're in a global epidemic of malnutrition. Of course, I know that in some parts of the world, you know, there's a hunger problem, but a global malnutrition epidemic. It turns out that that means both over and undernutrition. In the past thirty years, obesity rates have doubled in adults and triple children. The major nutritional issue used to be undernourishment. In the nineteen seventies, thirty five percent of the world's

population were undernourished. Now that's twelve percent, and most of the countries affected are experiencing conflict or war. So I guess that shows that nutrition is linked to many other problems, like not just poverty, and again the contrasts are crazy. While children in the developed world are increasingly at risk of obesity, one out of six children that's roughly one

hundred million children in developing countries is underweight. Diet contributes to almost seven hundred thousand deaths each year here in the US from things like heart disease, cancer, and type two diabetes. In fact, according to the World Health Organization, diet quality is now the leading contributing factor of death and disability worldwide. It's actually a super helpful and extremely

informative discussion between Jacob Weisberg and Roy Steiner. Roy's work heading up the Food Initiative at the Rockefeller Foundation is all about creating access to nourishing food for millions of people in the US and around the world, and supporting scientific advances in human nutrition and sustainable food production. This is relevant to every one of us, and I think you'll enjoy it. It's ultimately very positive and doable, Roy, Thanks for joining us, unsolvable. Thanks nice to be here.

So what is the problem. In a nutshell, we currently have a food system that does not result in good health for a lot of people, and it also damages the environment. We've optimized our food system for two things, production of calories and profit. We have not optimized it for nutrition, health, environment, culture, or community. And the food system needs to do all of those things. So we need to restructure, revolutionize a system so that it really

does nourish people with the foods they really need. My solvable is that we can reduce diet related diseases by fifty percent in our lifetime. Ro What is it about this problem that makes you want to calcole it? This problem affects billions of people, and it is actually getting worse rather than getting better. It's one of those trends that if we don't address inflict, untold suffering and cost on society. So I want to start with a phrase

you use, diet related diseases. What are diet related diseases? So we're starting to understand that there is a whole range of diseases diabetes, cardiovastual disease, some cancers that are result of not eating what scientists called protective diets. We don't eat enough fruits, vegetables, fish, legume, seeds. These things actually act in the body to protect us from these range of diseases, and they do that working through the microbiome,

through regulatory functions, through improving cellular function. And we're just starting to fully understand how important consumption of these foods are. And it's the under consumption of these foods that actually increase your risk more than anything else. Maybe a little glib, but people sometimes say, we're moving from the problems of not enough food to overabundance of food. Do you see it that way? We're moving to the problem of overabundance

of nutrient poor food. We have a lot of ultraprocessed food, but that is not what human beings thrive on. We are not producing or consuming enough of these protective foods. In fact, that most ten percent of Americans and Ethiopians eat the optical amount of fruits and vegetables, for example. They may not eat the same things they should eat, but surely they eat different things they shouldn't eat. Yes,

that is correct. I mean I have to think the problem is just very, very different in the United States and then in other developed countries, and then in the developing world. Yes, I mean there's still lots of places in the world where people aren't getting enough food, like we have under nutrition, not enough calories, but We are increasingly finding that people have enough calories, but they don't have enough nutrition. And that is actually a universal problem.

That's not just in the United States or in Africa, or in China or India. It's everywhere, and where they don't get enough calories, that's increasingly a political problem, right, It's absolutely food isn't getting to them because of civil war or bad government or some sort of crisis that the system can't deal with. Yeah. Absolutely, almost every famine is the result of poor governments or conflict. You make this a little more vivid for us, I mean, what

are the kinds of consequences. I know, diabetes obviously in this country, and their range of diseases that come from not having the protective diet you're talking about, But what does this look like to someone like you who's trying to get a global perspective on it. Well, one of the most extraordinary trends you see in the world, in the United States and everywhere else is this dramatic rise in diabetes and pre diabetes. Right now, we have four

hundred million people in the world with diabetes. That's going to grow to six hundred million in ten to twenty years. Fifty percent of American children, if the trend continues, will suffer from diabetes in their lifetime. And when you think about this trend, which you know right now, India has seventy million people with diabetes, China is on track it

has even more, and the consequences are incredibly severe. During the entire Irana Rock War there is a thousand and seven hundred amputations, which is just terrible for the soldiers. But just last year alone, there were eighty three thousand amputations due to diabetes in the United States, and we're going to increasingly see that all over the world, and the suffering and pain and cost of that is really

going to be a huge burden on healthcare systems. Some people have said that our food system right now is bankrupting our healthcare system. You see it as inevitable that developing countries follow this path in the United States towards over consumption of overly processed foods that are cheap, partly because of governmental subsidies. Right now, that is the trend.

We're hoping that we can change that trend by a number of interventions, including education, but changing the supply chain, and as you said, subsidies really do influence the food system in a very dramatic way. Of the agricultural subsidies in the United States go to six crops, eighty five percent of research goes to those same six crops, So we're ignoring actually the foods that make us really healthy,

that protect us, and we need to rebalance that. You're solvable is to reduce diet related diseases by half over a generation. What has to happen for that to be possible? What diseases get reduced and how can you see that happening. The most important thing is that we actually start eating optimal levels of these protective foods fruits, vegetables, nuts, seeds, lagoons, fish, etc. The nutritional science is showing that when you do eat those levels of optimal foods, we see dramatic reductions in

a range of these diseases. The most quickest way the sea impact is actually in diabetes pre diabetes, but we think that that has impact on cardiovastral disease and multiple other diseases which happen over a long period of time. These are chronic, noncommunical diseases. People in this country, and I don't think they're alone or they're diet is a

very personal thing. They don't necessarily like people on the outside, whether they're medical experts or policy experts, or people in the media telling them that they eat too much, that they eat badly, that they're too heavy. This is a cultural issue, not not just a dietary one. Right. Absolutely, the last thing I want to be in my family is the food police. You know, people take their diets very personally. No one likes to be told what to eat. And the fact is we have a lot of information.

It's an information, isn't the problem. I mean, all of our mothers told us to eat our foods and vegetables. So it's got to be a lot more than that. And it starts with changing, for example, the food environment. We have surrounded ourselves with really bad food, food that increases our risk. You just think about the kinds of lunches that are often served in workplaces and in schools.

They're just ultra process and there isn't choice to eat in healthy ways, or the healthy food is not necessarily tasty or cost effective, and so we have to actually, you know, people are going to make choices based on taste, on convenience, and on cost. And if we can't make healthy food, protective foods, tasty, convenient, and lower cost. We're not going to be able to do the shift, but we can do all of those things. An economist looks at this and says, well, this is an easy problem.

Instead of subsidizing the unhealthy food, tax the unhealthy food and subsidize the healthy food. I mean, isn't that the core of it. Well, I think that would be helpful, but that's not going to solve the entire problem. Yes, taxing sugar, for example, and subsidizing the healthier food will definitely be part of the way. You have to bring people along. We have to get the chefs of the world to really help us make this shift, and they're

starting to do that. There's a real movement in the food industry to create healthier, tasteier food, and you really see that, certainly at expensive restaurants in New York or Brooklyn or San Francisco. But the problem isn't people who have the means to eat healthy. They probably are eating healthier, right. Yes, the biggest burden, as so many things in society, falls on the poor and the vulnerable, who suffer from higher levels of these dyed related diseases and to a large

extent is because they don't have access to it. There are cultural issues, and it does cost more. We talk about the Green Revolution, which the Rockfeller Foundation was intimately involved in, as a kind of lightning strike, a sea change that change the problem of malnutrition fundamentally. Can you imagine something comparable that has a transformative effect on global diets? Absolutely? Well, you know, the Green Revolution took twenty five years, so

changing the food systems is a long term game. But I think we have to. It's not a question whether we want to or should. If we don't do that, our healthcare costs are going to get even more exorbitant than they are. And the food system is currently the largest emitter of global warming gases, and so we have to create a food system that's both more nourishing and environmentally sustainable. It is something that has to happen if

we're going to have the future we would desire. You mentioned Ethiopia as a country that's tragically gone from classical malnutrition to in a way more modern kind of malnutrition. They have solved our ended process of solving the issue of undernutrition, and it's not all the way there, but you know, in the last five years, Ethiopia has made men the strides, so that a country that once was best known for images of starving children is actually exporting

some commodities. But they, like almost every other country in the world, have this trend towards you know, lots of carbohydrates and not enough of these protective foods. We're in the developing world, ROYD. You see positive signs are their places where government policy or cultural changes are leading to improvement in the quality of diet. You see pockets of it.

You know, the countries that stand out for really making good dietary choices are places like Chili and Canada and the Scandinavian But you'll see increasing emphasis in for example, Rwanda or Ethiopia on supply chains of these nutritious foods. You're talking about getting fresh fruits and vegetables and grains and nuts and seeds to market. I mean a lot of the problem is that many of these foods are very perishable, unlike foods that get highly processed and have

our shelf stable. We think, for example, a place like African countries, they are suffering from supply chains that are pretty inefficient and you will lose often fifty percent of your crop because of poor transport or spoilage, and matching supply and demand in that environment is really important. But we have a lot of the tools that are necessary. A lot of this is data, a lot of these are these new technologies for storage and processing and drying.

The solar technology is revolutionizing every aspect of the economies in those countries, and we think that that can change the way agricultural supply chains operate. So what does that look like in Rwanda? Say we could have solar powered processing and drying so that instead of tomatoes rotting, you can dry them and that makes them much more shelf stable for a long time. Or fruits like mangoes and passion food, etc. Also process in a way that allows

them to last longer. There's some very interesting solar powered cooling solutions, for example, that create ice and then you can keep things a lot longer in those contexts, and those were just not cost effective vibe or even or ten years ago, but they're becoming because of technology. Because of innovation, those things are now possible. Right. There's the macro, which we've been talking about, and then there's the micro,

which is people's behavior and people's habits. And I have to ask you, as someone who's been reckoning with this issue, what kind of evolution has happened in your own diet, your own family. How have you tried to move towards a more protective diet at the Steiner home. Well, that's why I say, no one really likes being told what to eat. I think you have to make changes by yourself and by educating others, and over time that starts

to influence the family. My son and wife still really love bacon, and that's not a protective food, but they eat very high quantities of fruits and vegetables. And at the end of the day, it's really as long as you're consuming enough of these protective foods, you can eat your other favorite foods. It's really a matter of balance. And I think we will gradually as we develop taste and we get more comfortable, we're going to see these shifts.

And you're already seeing them in the new generation. Right there's this incredible shift in demand for healthier food in the millennial generation. I'm having a vision of Roy's plate at dinner, heaped high with keenoa and peas and broccoli, the other plates at the table having different different proportions of things that people might be more excited to eat. Well, actually, you know, the difference in meals is mostly breakfast, where

I eat very differently than my family. But I think lunch and dinner, I mean, everybody, there's so many taste dishes that you can make. And you know, we love fish and make that a regular part and we'll eat foods that are cultural all the time. I think we make a mistake when you get very rigid. We just don't know enough to say this is the best diet for this particular person. We know what to say about diets at a population level, but you and meat can

have very different optimal diets. You know, we know now that the microbiome is very influential and on how we take in food. We have genetic factors, there's emotional factors. Food as touches on so many aspects of our reality. Well, its behavioral changes go getting people at scale tax or thoughts. It is probably even harder than the challenge of getting them to evolve their diets. Well, both are really hard.

And that being said is you know, I don't think we underestimate how difficult behavior change is, but we have done that in the past. I mean, just think about the change in smoking or dry or safety. You know, used to be no one wore seat belts and cars are really quite unsafe. Now they're incredibly safe as a result of behavior change, new regulations. Smoking is an example, where everybody used to smoke indoors in airplanes, which seems unthinkable now, but that changed over the course of a

generation because of multiple efforts to make that change. I've read conflicting things about obesity in the US. Is it still getting worse or has it flattened out or started to get better. It's still very very high. I mean, the estimates are thirty to forty percent of the United States are obese. Another third are overweight, and so you really have two thirds of the population that are suffering

in some form from metabolic disease. I have not seen any of the statistics that show that that's actually getting better. I do know that pre diabetes and diabetes continue to increase, and everybody knows that our healthcare costs continue to go up. The rate of increase almost has to decline because it's at such a high plateau. As you say, such a high proportion of the population is a besa overweight. What

role do doctors play in this? I mean, surely when people are dealing with the consequences of their diet, they're in a medical setting. That is a major area where we can improve. It turns out that the recommended number of days that a doctor study nutrition out of four years is four days, but in fact, on average it's only four hours. So essentially doctors learn almost nothing about nutrition, even though we now know that sixty to seventy percent

of all noncommunicable diseases are diet related. So that's a really big miss there, and that's true for many for nurses and other healthcare practitioners, and so we have to change that. Nutrition needs to become a really important part of medical training, and another Rockefeller Foundation will certainly help make that shift. Well, what sort of initiatives are underway where you see something positive happening in the way doctors

or healthcare professionals are trained. There is a movement among doctors who just recognizes that reality to increase the amount of training and focus on this. The other really interesting experiment that's being done is in what are called fresh food pharmacy prescriptions. So instead of writing a drug prescription, there are some hospitals and doctors that are experimenting with writing prescriptions for fruits and vegetables and the results are astounding.

So there's this one study the Geisinger Health did where they took about one hundred poorly managed diabetes patients and they put them on a fresh fruit prescription ten meals a week over the course of the year. The cost of that program was about two thousand and five hundred dollars around per person, but they saved fifty to two hundred thousand dollars per person because it reduced costs and the health outcomes were far better than any known drug

on the market. We need to enable doctors to prescribe nourishing good food because it's increasingly the right thing to do in a better way than our farm of focused a medical system. Thinking about policy in this country, we have a Department of Agriculture which administer as a lot of the subsidies and of course runs a lot of health programs and other things, but we don't have a kind of organ of food policy driving this change that has a seat at the cabinet table, for instance. Do

you think that would help? Is that possible? Well, anything that raises the issue of food and nutrition in government I think would be very helpful. I mean, there's some people who have proposed something like a National Institute of Nutrition, which would be similar to the natural when the stud of cancer, etc. And I think something like that, where we have credible institutions that really start funding nutritional research at the levels it should and can act with a

credible voice, is really important. Right now. There's so much confusing information, in some cases very purposefully confusing. People want to confuse the public. We need institutions that people can trust and say this is what we know about what's

healthy for you and what's not. I think, yeah, increased effort in that area it could be very very helpful, right I wonder if you can break your takeaways out into two categories, what people should think about doing in relation to their own diets, and then what they should think about trying to do about this problem nationally and globally. I think people can start thinking as much as possible about consuming adequate quantities of these foods that are protective.

It's not so much around on not eating the other stuff. It's much more positive to think, like how do I eat more of fruits and vegetables and nuts and in a way that satisfies your taste and creates joy. I think we need to demand better food for children and at our workplaces, and that is something parents everywhere can do to help shift institutions so that they are procuring food that's more nourishing and sustainable. I think removing junk

food from shop checkouts. We've designed our food environment so it's almost impossible to eat really well, and we're constantly triggering the purchase and consumption of foods that are just not good for us in large quantities. Then finally, I mean, actually look at your plate that you're eating. It should be at least half fruits and vegetables, about a quarter whole grains and other things, and then a small slice of protein. We're just not eating enough of these other

whole foods that are protective. And what can people do about the problem globally? If anything, you affect the globe by your individual action. When we are industrialized countries, we need to be encouraging the production and consumption of protective foods when we're doing international development work, for example, So Roy, the first question we ask everybody to get them warmed up is what did you have for breakfast today? I had some fruits and nuts. I really like pecans, apricots,

and some yogurt. And in your case, I'm gonna ask, what are you gonna have for lunch? Oh? I always have vegetables and salad for lunch, and then I'll splurage for dinner. Do you eat meat? I consider myself a flexitarian or I have a plant forward diet where I try to eat as many plants as possible. But I always make multiple exceptions. So the first exception is I

will eat anything anybody cooks for me with love. You know, when I go to somebody's house, I will not say I have a dietary restriction because I don't really have a health issue. And then the second is for the exceptionally delicious. There's a specific food that my mother used to always make called Gorma sebzi. It's this incredible lamb stew. If I ever get a chance to eat that gorma subsy that I'm going to eat that gorma subsans. Food

is about joy and about connection. There's a spiritual dimension to food, so it's not simply about the nutrition. It's about all of these other things. That makes us human. So the roystin or food rules are plant forward, don't be a pain in the ass for other people, enjoy food, don't be too rigid. Yes, I think that's a good set of rules. How do we maximize joy and health?

I just loved that conversation. You know, Roy has multiple degrees and a PhD in agricultural engineering and all arrestivos, and he's telling us that to save our own health and the planets, we need to maximize joy when it comes to eating. I really appreciate this holistic take on food.

The way we eat today is not sustainable. Agriculture accounts for seventy percent of all freshwater use, it takes up roughly half of the planet's vegetated land, and it's responsible for almost a quarter of all global greenhouse gas emissions. That's more than every car and ship and train and plane on Earth combined. So for our own sakes, let's shine a light for Roy and his work at the

Food Initiative. Plant Forward Baby Solvable is a collaboration between Pushkin Industries and the Rockefella Foundation, with production by Chalk and Blade. Pushkin's executive producer is Mia LaBelle. Engineering by Jason Gambrell and the fine Folks at GSI Studios. Original music composed by Pascal Wise. Special thanks to Maggie Taylor, Heather Faine, Julia Barton, Carlie Mgniori, share Vincent, Jacob Weisberg, and Malcolm Gladwell. You can learn more about solving today's

biggest problems at Rockefeller Foundation dot org slash solvable. I'm Mave Higgins. Now go solve it.