Understanding the scientific value of “Make America Healthy Again” (MAHA) can be challenging. The MAHA report — commissioned by President Donald Trump and overseen by Health Secretary Robert F. Kennedy, Jr — cited hundreds of sources, misinterpreting some and fabricating others.
Some of MAHA’s priorities are backed by well-established science and are worth supporting, according to a new University of Pennsylvania report published Wednesday on the Psychology of Eating and Consumer Health Lab website and obtained by Medscape Medical News for exclusive review.
“We may not agree with everything that the MAHA commission and [Kennedy] are putting forth,” said the UPenn report’s lead author Alyssa Moran, ScD, MPH, director of policy and research strategy at the Penn Center for Food and Nutrition Policy.
The MAHA report cited a paper written by epidemiologist Katherine Keyes, which she said she did not author. And several other researchers cited said their findings were misconstrued or misunderstood. Some paper citations were entirely made up, including two papers supposedly investigating the harm of direct-to-consumer advertising. After reports of the mistakes, the White House released a corrected version.
Still, some of the MAHA proposals echo reforms long championed by public health experts.
The UPenn paper highlights five of these: eliminating toxic chemicals from the food supply, prohibiting public subsidizing of sugary drinks and ultra-processed foods, protecting children from diet-related disease, reducing conflict of interest in nutrition research, and — perhaps most crucial for physicians — increasing access to nutrition services in healthcare.
“We’re kind of saying to the MAHA caucus, ‘Here’s your food policy roadmap,’” said Moran.
The Evidence Behind MAHA
For each of the areas identified, the UPenn report lists MAHA’s proposed actions, the scientific evidence behind them, and what policy the authors believe would be most effective in achieving that goal.
MAHA and the evidence agree on several points — for instance, MAHA’s criticism of self-affirmed “generally recognized as safe” (GRAS) food ingredients. Research shows that because GRAS allows food makers to use ingredients without FDA oversight (as long as they believe the safety standard is met), harmful ingredients find their way into the US food supply; an example is propylparaben, which may impact male fertility and sperm count. Other MAHA claims that few nutrition experts would dispute include that sugary drinks are addictive, ultraprocessed food intake is linked with chronic conditions, and energy drinks are dangerous for children.
MAHA also highlights the role of physicians in improving Americans’ nutrition. Alongside a set of proposed policies promoting nutrition support access in healthcare, the UPenn report shows evidence in favor of requiring nutrition training for doctors.
Research shows that medical counseling can be especially effective in helping patients manage cardiometabolic disease, yet many physicians lack confidence in their ability to give nutrition and diet advice. They may not have received training: Medical students are not required to take nutrition courses.
“This data point really stuck with me,” said Emily Broad Leib, a co-author of the UPenn report and director of Harvard Law School’s Center for Health Law and Policy Innovation and the Food Law and Policy Clinic, Cambridge, Massachusetts. “Before entering medical school, the majority of medical students believe that food is important to health, and upon graduation, the majority believe that food is not an important job.”
To change this, the UPenn report suggests mandating nutrition courses for all federally funded or employed physicians, and providing grants to pay for nutrition education for residents and medical students.
From the ‘War on Tobacco’ Playbook
One unifying thread weaves through all UPenn’s recommendations: regulation.
“Our key recommendations actually mirror the strategies that were really effective in reducing smoking by regulating the tobacco industry,” said Moran. “Each of the five areas that we’ve put forward have almost a direct correlation in the area of tobacco control.”
Jerold Mande, MPH, a former federal policy official and one of the architects of the FDA strategy against tobacco, said that “the levers” used historically to succeed in controlling tobacco were “funding and regulation.”
This may not be in line with the current administration’s intention to reduce regulation and cut funding (including to programs that provide food to children), but the UPenn researchers believe policy is the most effective — and possibly the only — way to substantially improve Americans’ diet and nutrition.
“It’s impossible to make a big impact on changing the food supply without investing in the regulatory agencies that oversee the food supply — [the] FDA and USDA [US Department of Agriculture], in particular,” said Moran.
The tobacco model also helps ensure that although each intervention is limited in scope, they are not too piecemeal to overhaul the quality of the average American’s diet. “What was so effective about the tobacco control movement is that we really implemented this comprehensive suite of policies,” said Moran. “That is exactly the tack we need to take with food.”
“There’s not going to be one single policy that’s going to magically improve healthy food access or change our diets overnight, but I think by implementing this suite of comprehensive policies, we can really reform the food system and make a real dent in the way that people eat,” she said.
‘A Very Sensible Report’
The report has limits. None of the authors are experts in food production, including farming and processing. Because of that, it “doesn’t do justice to some of the reforms in the actual production side of food that I think are really important,” said Broad Leib.
Complicating matters is the MAHA report’s lack of scientific rigor; in some ways, the UPenn report is responding to that. “Even if we have the same goal and share the sense [that] the food system is a problem and we need to fix it, I am really concerned about the lack of commitment to solid and accurate science,” said Broad Leib. It risks “undermining” any progress.
The UPenn researchers intentionally avoided the many proposals advanced by Kennedy that are not backed by science, choosing to build on what’s known to be effective.
For the most part, experts find merit in the UPenn paper. “This is a very sensible report with a lot of recommendations that echo prior work,” said Dariush Mozaffarian, MD, cardiologist and director of the Food is Medicine Institute at Tufts University’s Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy.
Mande called the paper “terrific,” saying it shows how the MAHA report could benefit from the support of public health leaders. “It’s how public health should respond to the [MAHA] report and how I hope more will,” he said.
