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MAHA REPORT 30  JUL / AUG 2025 I  HEALTHCARE JOURNAL OF NEW ORLEANS   leading nutrition-related journals in 2018. PLoS ONE 15(12): e0243144. 178 Lesser LI, Ebbeling CB, Goozner M, Wypij D, Ludwig DS (2007) Relationship between funding source and conclusion among nutrition-related scientific articles. PLoS Med 4(1): e5. 179 Harris JL, Pomeranz JL, Lobstein T, Brownell KD. A crisis in the marketplace: how food marketing contributes to childhood obesity and what can be done. Annu Rev Public Health. 2009;30:211-25. 180 Tsochantaridou, A.; Sergentanis, T.N.; Grammatikopoulou, M.G.; Merakou, K.; Vassilakou, T.; Kornarou, E. Food Advertisement and Dietary Choices in Adolescents: An Overview of Recent Studies. Children 2023, 10, 442. 181 Smith R, Kelly B, Yeatman H, Boyland E. Food Marketing Influences Children’s Attitudes, Preferences and Consumption: A Systematic Critical Review. Nutrients. 2019 Apr 18;11(4):875. 182 Cairns G, Angus K, Hastings G, Caraher M. Systematic reviews of the evidence on the nature, extent and effects of food marketing to children. A retrospective summary. Appetite. 2013 Mar;62:209-15. 183 National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Food and Nutrition Board; Committee to Review the Process to Update the Dietary Guidelines for Americans. Redesigning the Process for Establishing the Dietary Guidelines for Americans. Washington (DC): National Academies Press (US); 2017 Nov 16. 2, Role and Purposes of the Dietary Guidelines for Americans: Evaluation and Findings. Available from: https://www.ncbi.nlm.nih.gov/books/NBK469833/. 184 U.S. Department of Health and Human Services & U.S. Department of Agriculture. (2020). Dietary Guidelines for Americans, 2020-2025 (9th ed.). 185 U.S. Department of Health and Human Services & U.S. Department of Agriculture. (2020). Dietary Guidelines for Americans, 2020-2025 (9th ed.). 186 Wilson, M. M., Reedy, J., & Krebs-Smith, S. M. (2016). American diet quality: where it is, where it is heading, and what it could be. Journal of the Academy of Nutrition and Dietetics, 116(2), 302-310. 187 Tapsell LC, Neale EP, Satija A, and Hu FB. (2016) Foods, Nutrients, and Dietary Patterns: Interconnections and Implications for Dietary Guidelines. Advances in Nutrition 7(3). https://doi.org/10.3945/an.115.011718. 188 Mozaffarian, D., Rosenberg, I., & Uauy, R. (2018). History of modern nutrition science—implications for current research, dietary guidelines, and food policy. Bmj, 361. 189 United States Department of Agriculture & Health and Human Services. (2025). Myths vs. Facts: Correcting Misinformation about the Dietary Guidelines. https://www. cspinet.org/sites/default/files/2025-04/1.%20DGA%20Myths%20vs%20Facts_CSPI.pdf. 190 Ministry of Health of Brazil. (2014). Dietary guidelines for the Brazilian population (2nd ed.). https://bvsms.saude.gov.br/bvs/publicacoes/dietary_guidelines_brazilian_ population.pdf. 191 Ministry of Health, Labour and Welfare & Ministry of Agriculture, Forestry and Fisheries. (2005). Japanese food guide spinning top. https://www.maff.go.jp/e/policies/ standards and guidelines. In France, schools are required to source half their products from local sources and prohibit vending machines. 222 Japanese schools typically prepare meals on-site using whole ingredients, often from local farms and school gardens. 223 Nordic countries, such as Sweden and Finland, have established guidelines that emphasize unprocessed foods while strictly limiting high-fat, high-sugar, and high-sodium processed items. 224 225 The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is one example of a government program that is focused exclusively on the nutritional health of its participants—pregnant and breastfeeding women, women who recently had a baby, infants, and children up to 5 years of age. WIC provides nutrition education, food assistance, and support to approximately 6.7 million women and children up to age five as of 2024. 226 WIC has a proven track record of improving children’s health: • WIC allows health-conscious food purchase that are adjusted according to participants’life stage nutritional needs, including increased fruit and vegetable consumption, reductions in juice consumption, and reductions in calorie intake. 227 228 • Research has shown that recipients experience improved pregnancy outcomes, better birth weights, higher immunization rates, improved diet quality, and cognitive gains. 229 230 • A study showed the 2009WIC food package change may have helped reverse increasing childhood obesity rates. 231 SECTION TWO: THE CUMULATIVE LOAD OF CHEMICALS IN OUR ENVIRONMENT Chemical Exposures Protecting children has been a priority for the federal executive branch for nearly 30 years, and yet, as science and technology advance there is a need to assess our current system to ensure it continues to be effective in utilizing the best tools and information available. In 1997, President Bill Clinton signed Executive Order 13045, Protection of Children from Environmental Health Risks and Safety Risks , which required federal agencies to make it a high priority to identify and assess environmental health and safety risks that may disproportionately affect children and ensure effective policies, programs, activities, and standards that address them. 232 Environmental health and safety risks were defined as risks to health or to safety that are attributable to products or substances that the child is likely to come in contact with or ingest, such as the air we breathe, the food we eat, the water we drink or use for recreation, the soil we live on, and the products we use or are exposed to. The EO created the President’s Task Force on Environmental Health Risks and Safety Risks to Children and the Interagency Forum on Child and Family Statistics. 233 234 As depicted by the figure above, the U.S. Environmental Protection Agency (EPA) has a robust risk-based approach that considers hazard and exposure for assessing the risks of chemicals, including pesticides, to human health and the environment. Since 2000, the EPAhas been tracking indicators of children’s environmental well-being through America’s Children and the Environment (ACE) . 235 ACE tracks chronic childhood disease in children (e.g., asthma, ADHD, autism, childhood cancers, and obesity) and summarizes trends over time for specific environmental exposures (e.g., air pollutants, drinking water contaminants, and chemicals in food). Many ACE indicators show significant improvements over time—such as exposure to lead which has been reduced over 90% since the 1970s and >70% reduction in key pollutants such as carbon monoxide, ozone, particulate matter (PM), nitrogen dioxide, and sulfur dioxide. 236 However, in 2025—28 years after EO 13045 was signed—childhood health has largely worsened, and there is a growing concern about the link between environmental health risks, particularly cumulative risks, and chronic disease. Furthermore, in the past nearly 30 years, the chemicals children are exposed to have grown - and no country fully understands how the cumulative impact of this growth impacts health.