Should Robert F. Kennedy Jr. are appointed Secretary of Health and Human Services, this will bring real political power to the network of wellness influencers who populate the Make America Health Again movement.
Doctors like me are concerned about many of Kennedy’s views on health. His anti-vaccine positions and calls to prosecute medical journals, among other dangerous positions, should never be normalized, disqualify the position he aspires to, and threaten to roll back decades of public health progress. In light of this, some have found solace in his and MAHA’s passion for tackling chronic diseases. But as a cardiologist in training who regularly sees patients struggling with chronic metabolic diseases such as high blood pressure, diabetes and obesity, I remain skeptical. In the MAHA universe, these diseases are self-inflicted wounds caused by poor dietary choices or a lack of discipline. Solutions for them often involve telling people to give up the junk food, avoid modern medicine, or buy an expensive product or service, with a hint of conspiracy.
But the reality I see in my clinic is very different. Certainly, Ultra-processed foods undoubtedly play a role in perpetuating metabolic diseases. I’m all about making healthier food more available and, most importantly, more affordable.
But chronic diseases, especially obesity and the metabolic diseases that result from it, are rooted in other far-reaching social and environmental issues, which are often beyond an individual’s control. Bone broth, nutraceuticals and raw milk will not address America’s metabolic disease epidemic.
If this is ultimately confirmed, Kennedy and his team are serious about tackling chronic disease, especially obesity, they would do well to reject the advice of out-of-touch influencers. He would primarily support expanding access to GLP-1 agonist therapies, which have been shown to have significant benefits in the treatment of metabolic diseases, for those who are eligible and interested, after consultation with their physicians. (A big part of expanding access would mean making them affordable.) That would mean to go back on his previous statements. ‘They count on sales [GLP-1s] to Americans because we are so stupid and so addicted to drugs,” he told Fox News.
Instead, he should look to what his uncle may have done: support a massive public health program that promotes evidence-based solutions, implemented locally and meeting people where they are. We could call it a Marshall Plan for obesity.
A successful program that he and his team can look at is for inspiration Metropolitan Area Project Plans (MAPS) 3 initiative in Oklahoma City, the capital of my home state. Implemented more than a decade ago, MAPS 3 was an ambitious, voter-approved infrastructure project motivated in part by rising obesity rates in the city noted by Republican Mayor Mick Cornett. The program took a systematic and holistic approach to obesity and used sales taxes to fund the construction of a downtown public park, a new streetcar transit system and multiple community wellness centers, as well as sidewalks and bike lanes throughout the city. The project was supervised by a volunteer citizen monitoring committee and was accompanied by a public health initiative announced by the mayor for the city zoo’s elephant exhibition (to express the seriousness of the situation), motivating citizens to lose. over 1 million pounds collective. In subsequent years, the city’s obesity rate declined stuck while the national rate grew.
To be clear, the program has its shortcomings, and the solutions for each community will invariably look different. But a similar, locally focused approach, uniting disparate programs already addressing obesity at the federal level, could be scaled nationally in a Marshall Plan for Obesity. The original plan brought Western Europe out of the aftermath of World War II through supply direct subsidies. Similarly, with a Marshall Plan for obesity, funding, primarily from federal appropriations, could be distributed in the form of grants to communities and spent on health projects by local governments, which can design programs that are equitable, inclusive and put people on the ground and involving the community. private sector. This could be further supplemented by consumption taxes on items such as tobacco, alcohol and sugar-sweetened drinks.
A program like this would be expensive. But so does the current cost of obesity in the United States more than 170 billion dollars in medical costs alone per year. Supported by a growing body of literature linking metabolic diseases to social and environmental determinants of health, such funding could be directed toward build affordable housing, creating green spaces And eliminating fitness desertscreating more walkable and pedestrian-friendly communities by improving our public transportation systems, handing out blood pressure cuffspromoting health and nutrition literacy, combating misinformation about medications such as statinsor offering credit at farmers markets. This program, in addition to expanding access to GLP-1 agonists, could complement efforts to reform our food system. It can also provide an opportunity to learn from each other and test what works and what doesn’t.
Of course, I like to say a lot of this. Kennedy built his career against the principles of modern medicine and public health, and while I (and we) may hope, he is unlikely to change his tune now. But stranger things have happened. The political status quo has been turned upside down, and people’s views on issues can evolve into positions of power. If Kennedy’s passion for this topic is genuine, he would look away from TikTok and Instagram posts promoting supplements and toward implementing evidence-based solutions that meet people where they are. Whether or not he and his team adopt these strategies, or others like them, the health of millions of Americans is simply too important to be sacrificed to fringe ideas and political views.
Vishal Khetpal is a cardiovascular disease fellow in the Brown University Cardiology Fellowship Program. The views expressed are those of the author and do not necessarily reflect the views of his employers.