WEBVTT - Poor Nutrition is Solvable 0:00:15.076 --> 0:00:21.676 Pushkin, I may have Higgins and this is Solvable Interviews 0:00:21.676 --> 0:00:24.996 with the world's most innovative thinkers working to solve the 0:00:24.996 --> 0:00:28.836 world's biggest problems. My name is Roy Steiner. I'm the 0:00:28.836 --> 0:00:32.356 managing director of the Food Initiative at the Rockefeller Foundation, 0:00:32.876 --> 0:00:37.356 and my solvable is to reduce by fifty percent diet 0:00:37.436 --> 0:00:41.476 related diseases in our generation. Okay, so this is a 0:00:41.556 --> 0:00:44.236 big one, but it wouldn't be solvable if it wasn't. 0:00:44.796 --> 0:00:48.036 When researching this episode, I was blown away to learn 0:00:48.116 --> 0:00:53.036 that today we're in a global epidemic of malnutrition. Of course, 0:00:53.116 --> 0:00:55.196 I know that in some parts of the world, you know, 0:00:55.316 --> 0:01:00.196 there's a hunger problem, but a global malnutrition epidemic. It 0:01:00.236 --> 0:01:05.316 turns out that that means both over and undernutrition. In 0:01:05.356 --> 0:01:08.476 the past thirty years, obesity rates have doubled in adults 0:01:08.476 --> 0:01:14.356 and triple children. The major nutritional issue used to be undernourishment. 0:01:15.036 --> 0:01:18.316 In the nineteen seventies, thirty five percent of the world's 0:01:18.356 --> 0:01:23.236 population were undernourished. Now that's twelve percent, and most of 0:01:23.236 --> 0:01:28.236 the countries affected are experiencing conflict or war. So I 0:01:28.276 --> 0:01:32.116 guess that shows that nutrition is linked to many other problems, 0:01:32.156 --> 0:01:36.436 like not just poverty, and again the contrasts are crazy. 0:01:37.036 --> 0:01:40.476 While children in the developed world are increasingly at risk 0:01:40.516 --> 0:01:44.596 of obesity, one out of six children that's roughly one 0:01:44.676 --> 0:01:51.316 hundred million children in developing countries is underweight. Diet contributes 0:01:51.396 --> 0:01:54.996 to almost seven hundred thousand deaths each year here in 0:01:55.036 --> 0:01:58.876 the US from things like heart disease, cancer, and type 0:01:58.876 --> 0:02:02.996 two diabetes. In fact, according to the World Health Organization, 0:02:03.516 --> 0:02:07.276 diet quality is now the leading contributing factor of death 0:02:07.356 --> 0:02:14.076 and disability worldwide. It's actually a super helpful and extremely 0:02:14.156 --> 0:02:19.756 informative discussion between Jacob Weisberg and Roy Steiner. Roy's work 0:02:19.836 --> 0:02:23.396 heading up the Food Initiative at the Rockefeller Foundation is 0:02:23.476 --> 0:02:27.796 all about creating access to nourishing food for millions of 0:02:27.876 --> 0:02:31.916 people in the US and around the world, and supporting 0:02:31.996 --> 0:02:36.916 scientific advances in human nutrition and sustainable food production. This 0:02:37.036 --> 0:02:40.116 is relevant to every one of us, and I think 0:02:40.116 --> 0:02:46.276 you'll enjoy it. It's ultimately very positive and doable, Roy, 0:02:46.316 --> 0:02:50.276 Thanks for joining us, unsolvable. Thanks nice to be here. 0:02:50.476 --> 0:02:54.756 So what is the problem. In a nutshell, we currently 0:02:54.756 --> 0:02:59.716 have a food system that does not result in good 0:02:59.756 --> 0:03:03.316 health for a lot of people, and it also damages 0:03:03.356 --> 0:03:06.996 the environment. We've optimized our food system for two things, 0:03:07.156 --> 0:03:10.396 production of calories and profit. We have not optimized it 0:03:10.436 --> 0:03:15.236 for nutrition, health, environment, culture, or community. And the food 0:03:15.236 --> 0:03:17.876 system needs to do all of those things. So we 0:03:17.916 --> 0:03:21.156 need to restructure, revolutionize a system so that it really 0:03:21.236 --> 0:03:25.436 does nourish people with the foods they really need. My 0:03:25.556 --> 0:03:31.236 solvable is that we can reduce diet related diseases by 0:03:31.316 --> 0:03:36.436 fifty percent in our lifetime. Ro What is it about 0:03:36.516 --> 0:03:39.516 this problem that makes you want to calcole it? This 0:03:39.556 --> 0:03:45.156 problem affects billions of people, and it is actually getting 0:03:45.196 --> 0:03:48.836 worse rather than getting better. It's one of those trends 0:03:48.876 --> 0:03:53.356 that if we don't address inflict, untold suffering and cost 0:03:53.516 --> 0:03:56.596 on society. So I want to start with a phrase 0:03:56.676 --> 0:04:01.756 you use, diet related diseases. What are diet related diseases? 0:04:02.676 --> 0:04:05.076 So we're starting to understand that there is a whole 0:04:05.316 --> 0:04:10.716 range of diseases diabetes, cardiovastual disease, some cancers that are 0:04:10.836 --> 0:04:15.636 result of not eating what scientists called protective diets. We 0:04:15.716 --> 0:04:21.116 don't eat enough fruits, vegetables, fish, legume, seeds. These things 0:04:21.276 --> 0:04:25.076 actually act in the body to protect us from these 0:04:25.196 --> 0:04:29.996 range of diseases, and they do that working through the microbiome, 0:04:30.436 --> 0:04:35.236 through regulatory functions, through improving cellular function. And we're just 0:04:35.316 --> 0:04:40.676 starting to fully understand how important consumption of these foods are. 0:04:41.476 --> 0:04:44.956 And it's the under consumption of these foods that actually 0:04:44.996 --> 0:04:49.076 increase your risk more than anything else. Maybe a little glib, 0:04:49.116 --> 0:04:52.556 but people sometimes say, we're moving from the problems of 0:04:52.836 --> 0:04:56.396 not enough food to overabundance of food. Do you see 0:04:56.396 --> 0:05:01.156 it that way? We're moving to the problem of overabundance 0:05:01.276 --> 0:05:06.156 of nutrient poor food. We have a lot of ultraprocessed food, 0:05:06.356 --> 0:05:09.276 but that is not what human beings thrive on. We 0:05:09.316 --> 0:05:12.836 are not producing or consuming enough of these protective foods. 0:05:13.156 --> 0:05:16.596 In fact, that most ten percent of Americans and Ethiopians 0:05:16.596 --> 0:05:19.356 eat the optical amount of fruits and vegetables, for example. 0:05:19.596 --> 0:05:21.876 They may not eat the same things they should eat, 0:05:22.116 --> 0:05:26.036 but surely they eat different things they shouldn't eat. Yes, 0:05:26.156 --> 0:05:28.036 that is correct. I mean I have to think the 0:05:28.076 --> 0:05:31.196 problem is just very, very different in the United States 0:05:31.236 --> 0:05:33.876 and then in other developed countries, and then in the 0:05:33.956 --> 0:05:36.996 developing world. Yes, I mean there's still lots of places 0:05:37.036 --> 0:05:40.316 in the world where people aren't getting enough food, like 0:05:40.356 --> 0:05:44.636 we have under nutrition, not enough calories, but We are 0:05:44.676 --> 0:05:48.156 increasingly finding that people have enough calories, but they don't 0:05:48.156 --> 0:05:52.196 have enough nutrition. And that is actually a universal problem. 0:05:52.276 --> 0:05:55.556 That's not just in the United States or in Africa, 0:05:55.636 --> 0:05:58.436 or in China or India. It's everywhere, and where they 0:05:58.436 --> 0:06:02.716 don't get enough calories, that's increasingly a political problem, right, 0:06:02.756 --> 0:06:05.996 It's absolutely food isn't getting to them because of civil 0:06:06.036 --> 0:06:10.956 war or bad government or some sort of crisis that 0:06:11.036 --> 0:06:14.836 the system can't deal with. Yeah. Absolutely, almost every famine 0:06:14.916 --> 0:06:18.836 is the result of poor governments or conflict. You make 0:06:18.836 --> 0:06:21.316 this a little more vivid for us, I mean, what 0:06:21.396 --> 0:06:25.116 are the kinds of consequences. I know, diabetes obviously in 0:06:25.156 --> 0:06:28.276 this country, and their range of diseases that come from 0:06:28.276 --> 0:06:31.796 not having the protective diet you're talking about, But what 0:06:31.836 --> 0:06:34.356 does this look like to someone like you who's trying 0:06:34.396 --> 0:06:36.996 to get a global perspective on it. Well, one of 0:06:37.036 --> 0:06:40.716 the most extraordinary trends you see in the world, in 0:06:40.716 --> 0:06:43.756 the United States and everywhere else is this dramatic rise 0:06:43.796 --> 0:06:46.596 in diabetes and pre diabetes. Right now, we have four 0:06:46.676 --> 0:06:49.516 hundred million people in the world with diabetes. That's going 0:06:49.556 --> 0:06:53.796 to grow to six hundred million in ten to twenty years. 0:06:53.836 --> 0:06:57.796 Fifty percent of American children, if the trend continues, will 0:06:57.836 --> 0:07:01.356 suffer from diabetes in their lifetime. And when you think 0:07:01.436 --> 0:07:05.356 about this trend, which you know right now, India has 0:07:05.436 --> 0:07:08.596 seventy million people with diabetes, China is on track it 0:07:08.636 --> 0:07:13.716 has even more, and the consequences are incredibly severe. During 0:07:13.716 --> 0:07:16.276 the entire Irana Rock War there is a thousand and 0:07:16.356 --> 0:07:20.116 seven hundred amputations, which is just terrible for the soldiers. 0:07:20.756 --> 0:07:23.796 But just last year alone, there were eighty three thousand 0:07:23.876 --> 0:07:27.676 amputations due to diabetes in the United States, and we're 0:07:27.676 --> 0:07:30.956 going to increasingly see that all over the world, and 0:07:31.076 --> 0:07:34.796 the suffering and pain and cost of that is really 0:07:35.076 --> 0:07:39.076 going to be a huge burden on healthcare systems. Some 0:07:39.116 --> 0:07:41.876 people have said that our food system right now is 0:07:41.956 --> 0:07:46.236 bankrupting our healthcare system. You see it as inevitable that 0:07:46.836 --> 0:07:50.796 developing countries follow this path in the United States towards 0:07:50.876 --> 0:07:56.676 over consumption of overly processed foods that are cheap, partly 0:07:56.716 --> 0:08:00.476 because of governmental subsidies. Right now, that is the trend. 0:08:00.796 --> 0:08:04.916 We're hoping that we can change that trend by a 0:08:05.036 --> 0:08:09.076 number of interventions, including education, but changing the supply chain, 0:08:09.516 --> 0:08:13.156 and as you said, subsidies really do influence the food 0:08:13.156 --> 0:08:17.476 system in a very dramatic way. Of the agricultural subsidies 0:08:17.476 --> 0:08:20.716 in the United States go to six crops, eighty five 0:08:20.756 --> 0:08:24.076 percent of research goes to those same six crops, So 0:08:24.116 --> 0:08:27.516 we're ignoring actually the foods that make us really healthy, 0:08:27.556 --> 0:08:31.716 that protect us, and we need to rebalance that. You're 0:08:32.036 --> 0:08:36.156 solvable is to reduce diet related diseases by half over 0:08:36.236 --> 0:08:40.036 a generation. What has to happen for that to be possible? 0:08:40.076 --> 0:08:43.116 What diseases get reduced and how can you see that happening. 0:08:43.516 --> 0:08:46.756 The most important thing is that we actually start eating 0:08:47.036 --> 0:08:53.636 optimal levels of these protective foods fruits, vegetables, nuts, seeds, lagoons, fish, etc. 0:08:54.196 --> 0:08:57.916 The nutritional science is showing that when you do eat 0:08:57.996 --> 0:09:03.436 those levels of optimal foods, we see dramatic reductions in 0:09:03.556 --> 0:09:06.396 a range of these diseases. The most quickest way the 0:09:06.516 --> 0:09:10.396 sea impact is actually in diabetes pre diabetes, but we 0:09:10.556 --> 0:09:13.876 think that that has impact on cardiovastral disease and multiple 0:09:13.916 --> 0:09:17.036 other diseases which happen over a long period of time. 0:09:17.116 --> 0:09:21.556 These are chronic, noncommunical diseases. People in this country, and 0:09:21.636 --> 0:09:23.596 I don't think they're alone or they're diet is a 0:09:23.636 --> 0:09:27.116 very personal thing. They don't necessarily like people on the outside, 0:09:27.156 --> 0:09:31.036 whether they're medical experts or policy experts, or people in 0:09:31.036 --> 0:09:34.556 the media telling them that they eat too much, that 0:09:34.636 --> 0:09:37.556 they eat badly, that they're too heavy. This is a 0:09:37.636 --> 0:09:42.116 cultural issue, not not just a dietary one. Right. Absolutely, 0:09:42.596 --> 0:09:45.076 the last thing I want to be in my family 0:09:45.156 --> 0:09:48.076 is the food police. You know, people take their diets 0:09:48.196 --> 0:09:51.156 very personally. No one likes to be told what to eat. 0:09:51.276 --> 0:09:53.276 And the fact is we have a lot of information. 0:09:53.436 --> 0:09:56.716 It's an information, isn't the problem. I mean, all of 0:09:56.716 --> 0:09:58.996 our mothers told us to eat our foods and vegetables. 0:09:59.236 --> 0:10:01.236 So it's got to be a lot more than that. 0:10:01.316 --> 0:10:04.836 And it starts with changing, for example, the food environment. 0:10:04.916 --> 0:10:09.156 We have surrounded ourselves with really bad food, food that 0:10:09.276 --> 0:10:12.556 increases our risk. You just think about the kinds of 0:10:12.676 --> 0:10:16.756 lunches that are often served in workplaces and in schools. 0:10:16.916 --> 0:10:20.556 They're just ultra process and there isn't choice to eat 0:10:20.676 --> 0:10:25.436 in healthy ways, or the healthy food is not necessarily 0:10:25.476 --> 0:10:29.956 tasty or cost effective, and so we have to actually, 0:10:29.956 --> 0:10:32.596 you know, people are going to make choices based on taste, 0:10:32.916 --> 0:10:36.756 on convenience, and on cost. And if we can't make 0:10:36.876 --> 0:10:42.236 healthy food, protective foods, tasty, convenient, and lower cost. We're 0:10:42.236 --> 0:10:43.996 not going to be able to do the shift, but 0:10:44.036 --> 0:10:46.956 we can do all of those things. An economist looks 0:10:46.956 --> 0:10:50.196 at this and says, well, this is an easy problem. 0:10:50.316 --> 0:10:54.476 Instead of subsidizing the unhealthy food, tax the unhealthy food 0:10:54.476 --> 0:10:57.076 and subsidize the healthy food. I mean, isn't that the 0:10:57.116 --> 0:10:59.876 core of it. Well, I think that would be helpful, 0:11:00.156 --> 0:11:02.476 but that's not going to solve the entire problem. Yes, 0:11:02.676 --> 0:11:07.676 taxing sugar, for example, and subsidizing the healthier food will 0:11:07.716 --> 0:11:09.796 definitely be part of the way. You have to bring 0:11:09.836 --> 0:11:12.876 people along. We have to get the chefs of the 0:11:12.916 --> 0:11:16.716 world to really help us make this shift, and they're 0:11:16.716 --> 0:11:19.316 starting to do that. There's a real movement in the 0:11:19.356 --> 0:11:23.716 food industry to create healthier, tasteier food, and you really 0:11:23.756 --> 0:11:27.396 see that, certainly at expensive restaurants in New York or 0:11:27.396 --> 0:11:32.396 Brooklyn or San Francisco. But the problem isn't people who 0:11:32.516 --> 0:11:36.516 have the means to eat healthy. They probably are eating healthier, right. Yes, 0:11:36.596 --> 0:11:40.316 the biggest burden, as so many things in society, falls 0:11:40.436 --> 0:11:44.196 on the poor and the vulnerable, who suffer from higher 0:11:44.276 --> 0:11:47.756 levels of these dyed related diseases and to a large 0:11:47.756 --> 0:11:50.956 extent is because they don't have access to it. There 0:11:50.996 --> 0:11:55.156 are cultural issues, and it does cost more. We talk 0:11:55.236 --> 0:11:59.236 about the Green Revolution, which the Rockfeller Foundation was intimately 0:11:59.316 --> 0:12:02.276 involved in, as a kind of lightning strike, a sea 0:12:02.396 --> 0:12:08.276 change that change the problem of malnutrition fundamentally. Can you 0:12:09.156 --> 0:12:14.596 imagine something comparable that has a transformative effect on global diets? Absolutely? Well, 0:12:14.596 --> 0:12:18.436 you know, the Green Revolution took twenty five years, so 0:12:18.676 --> 0:12:22.156 changing the food systems is a long term game. But 0:12:22.356 --> 0:12:25.316 I think we have to. It's not a question whether 0:12:25.556 --> 0:12:28.076 we want to or should. If we don't do that, 0:12:28.356 --> 0:12:31.516 our healthcare costs are going to get even more exorbitant 0:12:31.516 --> 0:12:34.676 than they are. And the food system is currently the 0:12:34.796 --> 0:12:38.316 largest emitter of global warming gases, and so we have 0:12:38.396 --> 0:12:41.796 to create a food system that's both more nourishing and 0:12:42.236 --> 0:12:46.356 environmentally sustainable. It is something that has to happen if 0:12:46.396 --> 0:12:49.356 we're going to have the future we would desire. You 0:12:49.396 --> 0:12:54.676 mentioned Ethiopia as a country that's tragically gone from classical 0:12:54.796 --> 0:12:58.796 malnutrition to in a way more modern kind of malnutrition. 0:12:59.476 --> 0:13:03.356 They have solved our ended process of solving the issue 0:13:03.356 --> 0:13:06.036 of undernutrition, and it's not all the way there, but 0:13:06.116 --> 0:13:08.676 you know, in the last five years, Ethiopia has made 0:13:09.196 --> 0:13:11.996 men the strides, so that a country that once was 0:13:12.316 --> 0:13:16.636 best known for images of starving children is actually exporting 0:13:16.716 --> 0:13:20.556 some commodities. But they, like almost every other country in 0:13:20.596 --> 0:13:24.356 the world, have this trend towards you know, lots of 0:13:24.396 --> 0:13:28.436 carbohydrates and not enough of these protective foods. We're in 0:13:28.476 --> 0:13:31.996 the developing world, ROYD. You see positive signs are their 0:13:32.076 --> 0:13:36.876 places where government policy or cultural changes are leading to 0:13:37.196 --> 0:13:41.436 improvement in the quality of diet. You see pockets of it. 0:13:41.876 --> 0:13:44.956 You know, the countries that stand out for really making 0:13:44.996 --> 0:13:49.756 good dietary choices are places like Chili and Canada and 0:13:49.796 --> 0:13:55.956 the Scandinavian But you'll see increasing emphasis in for example, 0:13:56.076 --> 0:14:00.356 Rwanda or Ethiopia on supply chains of these nutritious foods. 0:14:00.796 --> 0:14:05.476 You're talking about getting fresh fruits and vegetables and grains 0:14:05.476 --> 0:14:08.116 and nuts and seeds to market. I mean a lot 0:14:08.116 --> 0:14:10.276 of the problem is that many of these foods are 0:14:10.396 --> 0:14:13.876 very perishable, unlike foods that get highly processed and have 0:14:14.076 --> 0:14:17.076 our shelf stable. We think, for example, a place like 0:14:17.276 --> 0:14:21.236 African countries, they are suffering from supply chains that are 0:14:21.316 --> 0:14:25.956 pretty inefficient and you will lose often fifty percent of 0:14:25.996 --> 0:14:30.276 your crop because of poor transport or spoilage, and matching 0:14:30.396 --> 0:14:33.316 supply and demand in that environment is really important. But 0:14:33.396 --> 0:14:35.356 we have a lot of the tools that are necessary. 0:14:35.716 --> 0:14:37.836 A lot of this is data, a lot of these 0:14:37.876 --> 0:14:41.476 are these new technologies for storage and processing and drying. 0:14:41.796 --> 0:14:46.756 The solar technology is revolutionizing every aspect of the economies 0:14:46.756 --> 0:14:49.916 in those countries, and we think that that can change 0:14:49.956 --> 0:14:53.836 the way agricultural supply chains operate. So what does that 0:14:53.876 --> 0:14:58.676 look like in Rwanda? Say we could have solar powered 0:14:58.916 --> 0:15:03.556 processing and drying so that instead of tomatoes rotting, you 0:15:03.596 --> 0:15:06.716 can dry them and that makes them much more shelf 0:15:06.756 --> 0:15:10.556 stable for a long time. Or fruits like mangoes and 0:15:10.836 --> 0:15:14.436 passion food, etc. Also process in a way that allows 0:15:14.476 --> 0:15:18.716 them to last longer. There's some very interesting solar powered 0:15:18.756 --> 0:15:22.756 cooling solutions, for example, that create ice and then you 0:15:22.796 --> 0:15:26.356 can keep things a lot longer in those contexts, and 0:15:26.396 --> 0:15:29.916 those were just not cost effective vibe or even or 0:15:29.916 --> 0:15:33.396 ten years ago, but they're becoming because of technology. Because 0:15:33.436 --> 0:15:37.796 of innovation, those things are now possible. Right. There's the macro, 0:15:37.916 --> 0:15:40.436 which we've been talking about, and then there's the micro, 0:15:40.556 --> 0:15:44.036 which is people's behavior and people's habits. And I have 0:15:44.116 --> 0:15:46.956 to ask you, as someone who's been reckoning with this issue, 0:15:47.596 --> 0:15:51.556 what kind of evolution has happened in your own diet, 0:15:51.596 --> 0:15:54.036 your own family. How have you tried to move towards 0:15:54.076 --> 0:15:57.676 a more protective diet at the Steiner home. Well, that's 0:15:57.716 --> 0:16:00.556 why I say, no one really likes being told what 0:16:00.676 --> 0:16:05.036 to eat. I think you have to make changes by 0:16:05.076 --> 0:16:09.756 yourself and by educating others, and over time that starts 0:16:09.796 --> 0:16:14.276 to influence the family. My son and wife still really 0:16:14.316 --> 0:16:17.916 love bacon, and that's not a protective food, but they 0:16:17.956 --> 0:16:22.116 eat very high quantities of fruits and vegetables. And at 0:16:22.156 --> 0:16:24.076 the end of the day, it's really as long as 0:16:24.076 --> 0:16:26.716 you're consuming enough of these protective foods, you can eat 0:16:26.756 --> 0:16:30.036 your other favorite foods. It's really a matter of balance. 0:16:30.476 --> 0:16:34.236 And I think we will gradually as we develop taste 0:16:34.476 --> 0:16:38.196 and we get more comfortable, we're going to see these shifts. 0:16:38.196 --> 0:16:40.996 And you're already seeing them in the new generation. Right 0:16:40.996 --> 0:16:45.316 there's this incredible shift in demand for healthier food in 0:16:45.356 --> 0:16:48.796 the millennial generation. I'm having a vision of Roy's plate 0:16:48.796 --> 0:16:53.076 at dinner, heaped high with keenoa and peas and broccoli, 0:16:53.476 --> 0:16:56.996 the other plates at the table having different different proportions 0:16:56.996 --> 0:16:59.716 of things that people might be more excited to eat. Well, actually, 0:16:59.756 --> 0:17:03.356 you know, the difference in meals is mostly breakfast, where 0:17:03.396 --> 0:17:06.516 I eat very differently than my family. But I think 0:17:06.596 --> 0:17:09.036 lunch and dinner, I mean, everybody, there's so many taste 0:17:09.436 --> 0:17:11.596 dishes that you can make. And you know, we love 0:17:11.716 --> 0:17:15.076 fish and make that a regular part and we'll eat 0:17:15.396 --> 0:17:18.836 foods that are cultural all the time. I think we 0:17:18.876 --> 0:17:21.916 make a mistake when you get very rigid. We just 0:17:21.996 --> 0:17:25.236 don't know enough to say this is the best diet 0:17:25.316 --> 0:17:29.156 for this particular person. We know what to say about 0:17:29.196 --> 0:17:32.636 diets at a population level, but you and meat can 0:17:32.716 --> 0:17:37.196 have very different optimal diets. You know, we know now 0:17:37.236 --> 0:17:40.836 that the microbiome is very influential and on how we 0:17:41.196 --> 0:17:45.156 take in food. We have genetic factors, there's emotional factors. 0:17:45.236 --> 0:17:49.476 Food as touches on so many aspects of our reality. Well, 0:17:49.476 --> 0:17:53.916 its behavioral changes go getting people at scale tax or thoughts. 0:17:53.956 --> 0:17:57.476 It is probably even harder than the challenge of getting 0:17:57.476 --> 0:18:00.436 them to evolve their diets. Well, both are really hard. 0:18:00.956 --> 0:18:03.836 And that being said is you know, I don't think 0:18:03.836 --> 0:18:09.476 we underestimate how difficult behavior change is, but we have 0:18:09.636 --> 0:18:11.916 done that in the past. I mean, just think about 0:18:11.996 --> 0:18:15.556 the change in smoking or dry or safety. You know, 0:18:15.996 --> 0:18:18.836 used to be no one wore seat belts and cars 0:18:18.836 --> 0:18:22.276 are really quite unsafe. Now they're incredibly safe as a 0:18:22.316 --> 0:18:26.836 result of behavior change, new regulations. Smoking is an example, 0:18:26.876 --> 0:18:30.436 where everybody used to smoke indoors in airplanes, which seems 0:18:30.556 --> 0:18:34.276 unthinkable now, but that changed over the course of a 0:18:34.316 --> 0:18:39.396 generation because of multiple efforts to make that change. I've 0:18:39.396 --> 0:18:42.676 read conflicting things about obesity in the US. Is it 0:18:42.836 --> 0:18:46.196 still getting worse or has it flattened out or started 0:18:46.196 --> 0:18:49.316 to get better. It's still very very high. I mean, 0:18:49.436 --> 0:18:53.436 the estimates are thirty to forty percent of the United 0:18:53.476 --> 0:18:58.676 States are obese. Another third are overweight, and so you 0:18:58.716 --> 0:19:02.756 really have two thirds of the population that are suffering 0:19:02.796 --> 0:19:06.716 in some form from metabolic disease. I have not seen 0:19:06.836 --> 0:19:09.796 any of the statistics that show that that's actually getting better. 0:19:09.876 --> 0:19:13.676 I do know that pre diabetes and diabetes continue to increase, 0:19:14.156 --> 0:19:17.156 and everybody knows that our healthcare costs continue to go up. 0:19:17.836 --> 0:19:20.716 The rate of increase almost has to decline because it's 0:19:20.756 --> 0:19:22.836 at such a high plateau. As you say, such a 0:19:22.916 --> 0:19:26.556 high proportion of the population is a besa overweight. What 0:19:26.716 --> 0:19:29.436 role do doctors play in this? I mean, surely when 0:19:29.476 --> 0:19:32.636 people are dealing with the consequences of their diet, they're 0:19:32.636 --> 0:19:36.156 in a medical setting. That is a major area where 0:19:36.196 --> 0:19:39.596 we can improve. It turns out that the recommended number 0:19:39.596 --> 0:19:42.956 of days that a doctor study nutrition out of four 0:19:43.036 --> 0:19:47.356 years is four days, but in fact, on average it's 0:19:47.396 --> 0:19:52.116 only four hours. So essentially doctors learn almost nothing about nutrition, 0:19:52.556 --> 0:19:55.436 even though we now know that sixty to seventy percent 0:19:55.516 --> 0:19:58.716 of all noncommunicable diseases are diet related. So that's a 0:19:58.796 --> 0:20:02.596 really big miss there, and that's true for many for 0:20:02.716 --> 0:20:06.036 nurses and other healthcare practitioners, and so we have to 0:20:06.156 --> 0:20:10.036 change that. Nutrition needs to become a really important part 0:20:10.276 --> 0:20:15.556 of medical training, and another Rockefeller Foundation will certainly help 0:20:15.796 --> 0:20:19.596 make that shift. Well, what sort of initiatives are underway 0:20:19.596 --> 0:20:22.436 where you see something positive happening in the way doctors 0:20:22.556 --> 0:20:25.836 or healthcare professionals are trained. There is a movement among 0:20:25.956 --> 0:20:30.396 doctors who just recognizes that reality to increase the amount 0:20:30.396 --> 0:20:34.636 of training and focus on this. The other really interesting 0:20:34.916 --> 0:20:38.516 experiment that's being done is in what are called fresh 0:20:38.556 --> 0:20:44.236 food pharmacy prescriptions. So instead of writing a drug prescription, 0:20:44.436 --> 0:20:47.196 there are some hospitals and doctors that are experimenting with 0:20:47.356 --> 0:20:51.876 writing prescriptions for fruits and vegetables and the results are astounding. 0:20:52.116 --> 0:20:55.196 So there's this one study the Geisinger Health did where 0:20:55.236 --> 0:21:00.916 they took about one hundred poorly managed diabetes patients and 0:21:01.036 --> 0:21:03.836 they put them on a fresh fruit prescription ten meals 0:21:03.836 --> 0:21:06.876 a week over the course of the year. The cost 0:21:06.916 --> 0:21:10.236 of that program was about two thousand and five hundred 0:21:10.236 --> 0:21:14.636 dollars around per person, but they saved fifty to two 0:21:14.716 --> 0:21:18.276 hundred thousand dollars per person because it reduced costs and 0:21:18.356 --> 0:21:21.156 the health outcomes were far better than any known drug 0:21:21.196 --> 0:21:25.156 on the market. We need to enable doctors to prescribe 0:21:25.516 --> 0:21:30.276 nourishing good food because it's increasingly the right thing to 0:21:30.356 --> 0:21:33.396 do in a better way than our farm of focused 0:21:33.476 --> 0:21:37.996 a medical system. Thinking about policy in this country, we 0:21:38.076 --> 0:21:41.076 have a Department of Agriculture which administer as a lot 0:21:41.116 --> 0:21:42.836 of the subsidies and of course runs a lot of 0:21:42.836 --> 0:21:45.756 health programs and other things, but we don't have a 0:21:45.916 --> 0:21:50.676 kind of organ of food policy driving this change that 0:21:50.796 --> 0:21:53.436 has a seat at the cabinet table, for instance. Do 0:21:53.436 --> 0:21:56.396 you think that would help? Is that possible? Well, anything 0:21:56.516 --> 0:22:01.996 that raises the issue of food and nutrition in government 0:22:02.036 --> 0:22:04.196 I think would be very helpful. I mean, there's some 0:22:04.236 --> 0:22:07.516 people who have proposed something like a National Institute of Nutrition, 0:22:07.756 --> 0:22:09.556 which would be similar to the natural when the stud 0:22:09.596 --> 0:22:13.916 of cancer, etc. And I think something like that, where 0:22:13.996 --> 0:22:20.636 we have credible institutions that really start funding nutritional research 0:22:20.676 --> 0:22:23.356 at the levels it should and can act with a 0:22:23.396 --> 0:22:26.396 credible voice, is really important. Right now. There's so much 0:22:26.436 --> 0:22:31.876 confusing information, in some cases very purposefully confusing. People want 0:22:31.916 --> 0:22:35.716 to confuse the public. We need institutions that people can 0:22:35.756 --> 0:22:38.796 trust and say this is what we know about what's 0:22:38.836 --> 0:22:42.196 healthy for you and what's not. I think, yeah, increased 0:22:42.276 --> 0:22:44.596 effort in that area it could be very very helpful, 0:22:45.196 --> 0:22:48.156 right I wonder if you can break your takeaways out 0:22:48.196 --> 0:22:51.316 into two categories, what people should think about doing in 0:22:51.356 --> 0:22:54.676 relation to their own diets, and then what they should 0:22:54.756 --> 0:22:58.756 think about trying to do about this problem nationally and globally. 0:22:58.956 --> 0:23:02.556 I think people can start thinking as much as possible 0:23:02.596 --> 0:23:06.956 about consuming adequate quantities of these foods that are protective. 0:23:07.516 --> 0:23:10.836 It's not so much around on not eating the other stuff. 0:23:11.076 --> 0:23:13.316 It's much more positive to think, like how do I 0:23:13.396 --> 0:23:16.356 eat more of fruits and vegetables and nuts and in 0:23:16.396 --> 0:23:20.116 a way that satisfies your taste and creates joy. I 0:23:20.156 --> 0:23:23.916 think we need to demand better food for children and 0:23:23.996 --> 0:23:27.596 at our workplaces, and that is something parents everywhere can 0:23:27.636 --> 0:23:31.836 do to help shift institutions so that they are procuring 0:23:31.916 --> 0:23:36.636 food that's more nourishing and sustainable. I think removing junk 0:23:36.676 --> 0:23:40.436 food from shop checkouts. We've designed our food environment so 0:23:40.476 --> 0:23:44.476 it's almost impossible to eat really well, and we're constantly 0:23:44.476 --> 0:23:47.436 triggering the purchase and consumption of foods that are just 0:23:47.556 --> 0:23:51.356 not good for us in large quantities. Then finally, I mean, 0:23:51.476 --> 0:23:53.916 actually look at your plate that you're eating. It should 0:23:53.956 --> 0:23:57.396 be at least half fruits and vegetables, about a quarter 0:23:57.676 --> 0:24:01.076 whole grains and other things, and then a small slice 0:24:01.116 --> 0:24:05.076 of protein. We're just not eating enough of these other 0:24:05.316 --> 0:24:08.236 whole foods that are protective. And what can people do 0:24:08.276 --> 0:24:13.196 about the problem globally? If anything, you affect the globe 0:24:13.236 --> 0:24:18.756 by your individual action. When we are industrialized countries, we 0:24:18.876 --> 0:24:23.276 need to be encouraging the production and consumption of protective 0:24:23.316 --> 0:24:27.436 foods when we're doing international development work, for example, So Roy, 0:24:27.516 --> 0:24:30.076 the first question we ask everybody to get them warmed 0:24:30.116 --> 0:24:32.196 up is what did you have for breakfast today? I 0:24:32.276 --> 0:24:36.796 had some fruits and nuts. I really like pecans, apricots, 0:24:36.916 --> 0:24:39.836 and some yogurt. And in your case, I'm gonna ask, 0:24:39.916 --> 0:24:41.836 what are you gonna have for lunch? Oh? I always 0:24:41.876 --> 0:24:45.676 have vegetables and salad for lunch, and then I'll splurage 0:24:45.716 --> 0:24:48.476 for dinner. Do you eat meat? I consider myself a 0:24:48.516 --> 0:24:51.796 flexitarian or I have a plant forward diet where I 0:24:51.876 --> 0:24:54.876 try to eat as many plants as possible. But I 0:24:54.916 --> 0:24:58.876 always make multiple exceptions. So the first exception is I 0:24:58.876 --> 0:25:01.556 will eat anything anybody cooks for me with love. You know, 0:25:01.596 --> 0:25:03.796 when I go to somebody's house, I will not say 0:25:04.036 --> 0:25:06.596 I have a dietary restriction because I don't really have 0:25:06.676 --> 0:25:08.996 a health issue. And then the second is for the 0:25:09.196 --> 0:25:12.836 exceptionally delicious. There's a specific food that my mother used 0:25:12.876 --> 0:25:16.596 to always make called Gorma sebzi. It's this incredible lamb stew. 0:25:16.956 --> 0:25:19.396 If I ever get a chance to eat that gorma 0:25:19.476 --> 0:25:22.236 subsy that I'm going to eat that gorma subsans. Food 0:25:22.276 --> 0:25:25.636 is about joy and about connection. There's a spiritual dimension 0:25:25.676 --> 0:25:29.516 to food, so it's not simply about the nutrition. It's 0:25:29.556 --> 0:25:33.276 about all of these other things. That makes us human. 0:25:33.756 --> 0:25:39.516