HJNO Jul/Aug 2025

MAHA REPORT 28  JUL / AUG 2025 I  HEALTHCARE JOURNAL OF NEW ORLEANS   metabolism in patients with T2DM: a systematic review and meta-analysis. Nutrition & Diabetes, 10(1). https://doi.org/10.1038/s41387-020-00142-z. 164 Fechner, E., Smeets, E., Schrauwen, P., & Mensink, R. (2020). The Effects of Different Degrees of Carbohydrate Restriction and Carbohydrate Replacement on Cardiometabolic Risk Markers in Humans—A Systematic Review and Meta-Analysis. Nutrients, 12(4), 991. https://doi.org/10.3390/nu12040991. 165 Cucuzzella, M., Bailes, J., Favret, J., Paddu, N., & Bradley, A. B. (2024). Beyond Obesity and Overweight: The Clinical Assessment and Treatment of Excess Body Fat in Children. In Current Obesity Reports (Vol. 13, Issue 2, pp. 276–285). Springer Science and Business Media LLC. https://doi.org/10.1007/s13679-024-00565-0. 166 McKenzie, A. L., Athinarayanan, S. J., Van Tieghem, M. R., Volk, B. M., Roberts, C. G. P., Adams, R. N., Volek, J. S., Phinney, S. D., & Hallberg, S. J. (2024). 5-Year effects of a novel continuous remote care model with carbohydrate-restricted nutrition therapy including nutritional ketosis in type 2 diabetes: An extension study. Diabetes Research and Clinical Practice, 217, 111898. https://doi.org/10.1016/j.diabres.2024.111898. 167 U.S. Department of Agriculture, Economic Research Service. (2023). Food dollar series: Overview. https://www.ers.usda.gov/data- products/food-dollar-series/. 168 Nguyen, K. H., Glantz, S. A., Palmer, C. N., & Schmidt, L. A. (2019). Tobacco industry involvement in children’s sugary drinks market. BMJ, 364. 169 Nguyen, K. H., Glantz, S. A., Palmer, C. N., & Schmidt, L. A. (2020). Transferring racial/ethnic marketing strategies from tobacco to food corporations: Philip Morris and Kraft General Foods. American journal of public health, 110(3), 329-336. 170 MacDonald, J. M. (2024, January 25). Four largest U.S. meatpackers’ share of cattle and hog purchases surged after 1980 [Chart]. Economic Research Service, U.S. Department of Agriculture. Retrieved May 9, 2025, from https://www.ers.usda.gov/data-products/chart-gallery/chart- detail?chartId=108341. 171 Boys, K. A., Ollinger, M., & Geyer, L. L. (2015). The Food Safety Modernization Act: implications for US small scale farms. American journal of law & medicine, 41(2-3), 395-405. 172 Dima, A., Radu, E., & Dobrin, C. (2024). Exploring Key Barriers of HACCP Certification Adoption in the Meat Industry: A Decision-Making Trial and Evaluation Laboratory Approach. Foods, 13(9), 1303. 173 Mozaffarian, D., and N. G. Forouhi. 2018. Dietary guidelines and health—is nutrition science up to the task? BMJ 360:k822. https://doi.org/10.1136/bmj.k822. 174 Toole, A.A. & Kuchler, F. (2015). Improving Health Through Nutrition Research: An Overview of the U.S. Nutrition Research System. U.S. Department of Agriculture, Economic Research Service. ERR-182. 175 Fleischhacker SE, Woteki CE, Coates PM, Hubbard VS, Flaherty GE, Glickman DR, Harkin TR, Kessler D, Li WW, Loscalzo J, Parekh A, Rowe S, Stover PJ, Tagtow A, Yun AJ, Mozaffarian D. Strengthening national nutrition research: rationale and options for a new coordinated federal research effort and authority. Am J Clin Nutr. 2020 Sep 1;112(3):721-769. doi: 10.1093/ajcn/nqaa179. PMID: 32687145; PMCID: PMC7454258. 176 Kearns CE, Schmidt LA, Glantz SA. Sugar Industry and Coronary Heart Disease Research: A Historical Analysis of Internal Industry Documents. JAMA Intern Med. 2016 Nov 1;176(11):1680-1685. doi: 10.1001/jamainternmed.2016.5394. Erratum in: JAMA Intern Med. 2016 Nov 1;176(11):1729. doi: 10.1001/jamainternmed.2016.6774. PMID: 27617709; PMCID: PMC5099084. 177 Sacks G, Riesenberg D, Mialon M, Dean S, Cameron AJ (2020) The characteristics and extent of food industry involvement in peer reviewed research articles from 10 Traditional Field Crops vs. Specialty Crops: Historically, federal crop insurance programs have primarily covered traditional field crops like wheat, corn, and soybeans, while providing much less support for specialty crops such as fruits, vegetables, tree nuts, and nursery plants. 200 While specialty crop coverage has been expanding, it still only accounted for 17% of the entire federal crop insurance portfolio by liability during crop year 2017, and subsidies for fruits, vegetables, tree nuts, and support for organic foods account for a mere 0.1% of the 2018 Farm Bill. 201 Just over 80% of Farm Bill spending is devoted to the Supplemental Nutrition Assistance Program, described further below. The Supplemental NutritionAssistance Program (SNAP) served on average 42 million low- incomeAmericans per month with Federal SNAP spending totaling $113 billion in fiscal year 2023. 202203 1 in 5American children 17 and under receive SNAP benefits. 204 SNAP participants can buy everything on grocery store shelves with the exception of alcohol, hot foods, tobacco and non-food products. 205 • Children receiving SNAP benefits are more likely to consume greater quantities of sugar- sweetened beverages and processedmeats compared to income-eligible nonrecipients; 206 207 by one estimate, nearly twice as much will be spent by SNAP on UPFs and sugar-sweetened beverages ($21 billion) compared to fruits and vegetables ($11 billion) in FY2025. 208 209 • SNAP participants face worsening health outcomes compared to non-participants, exhibiting elevated disease risks: according to one study, they are twice as likely to develop heart disease, three times more likely to die from diabetes, and have higher rates of metabolic disorders. 210 Additionally, children on SNAP can struggle to meet key dietary guidelines and perform poorly on key health indicators when compared with income-eligible and higher income nonparticipants. 211 • The costs for these preventable diseases fall directly on taxpayers. Roughly 60% of SNAP participants received Medicaid in 2019, highlighting the connection between healthcare costs and suboptimal nutritional services. 212 SNAP currently has incentives in place to encourage increased consumption of fruit, vegetables, dairy, and whole grains. These incentive programs encourage healthy eating by making nutritious food more accessible and affordable through coupons, discounts, gift cards, bonus items, or extra funds. 213 Other countries steer food-assistance recipients toward healthier dietary choices rather than merely emphasizing caloric intake. For example, South Korea and Chile implement food voucher programs similar to SNAP but prioritize domestic and nutritious food products, effectively guiding recipients toward healthier eating habits. 214 215 The School Breakfast Program and National School Lunch Program (NSLP) operates in nearly 100,000 schools covering more than 30 million children, 216 with an annual cost of $24 billion, 217 and yet: • Schools that receive federal lunch subsidies are required to follow a meal pattern that limits added sugars, sodium, and carbohydrates, but do not set limits on UPF consumption, leading to excessive intake of sugar, processed carbohydrates, processed fats, and sodium among children. 218 • To get into schools, many food companies have reformulated their products with minor ingredient adjustments to qualify for the federal Smart Snack program by meeting the school nutrition standards, which children can purchase separate from school meals. 219 • There are concerns that providing these snacks in school can confuse students’ perceptions of healthy foods, 220 especially since Smart Snacks are often virtually indistinguishable from less-nutritious versions of fast food products available outside of school. 221 While the U.S. has long had programs that both incentivize fruits and vegetables, other countries’school lunch programs have additional SNAP Average Monthly Benefit (Ranked per Person) - FY 2023: • Per person: $200.92 • Per household: $351.28 U.S. Overall Average: • Per person: $208.75 • Per household: $365.75 Source: https://fns-prod.azureedge.us/sites/ default/files/resource-files/snap-sar-fy23.pdf