Shortly after Robert F. Kennedy, Jr. was sworn into office as the next Secretary of Health and Human Services, President Trump established by way of executive order a Make America Healthy Again Commission, tasked with examining and addressing the root causes of America’s “health crisis.” Its initial focus will be on childhood health, specifically related to chronic disease. However, much of what’s contained in the executive order isn’t new. With the conspicuous exception of the first Trump administration, going back decades—under successive administrations—the federal government and medical community have pursued policies that investigate causes of chronic disease and how best to tackle them. Where the Commission differs from previous initiatives is its accentuating children and directing efforts to assess what the order calls “over-utilization” of certain medications and pesticides and possible undue “corporate influence.”
The White House issued an executive order yesterday that spells out the main purpose of the Make America Healthy Again Commission, specifically to “re-direct our national focus, in the public and private sectors, toward understanding and drastically lowering chronic disease rates and ending childhood chronic disease. This includes fresh thinking on nutrition, physical activity, healthy lifestyles.” At first, the Commission will examine data on childhood health and evaluate current programs targeting the pediatric population.
The executive order echoes what Kennedy has spoken of regarding his desire for Americans to be more physically active and eat healthier and to reduce the use of pesticides and fix what Kennedy depicts as a food ecosystem captured by corporate interests.
But despite the administration’s initiative being touted as novel, there’s little new here. And contrary to Kennedy’s claims that infectious diseases receive far more federal funding than chronic diseases, the National Institutes of Health have poured more into the latter than the former. Besides funding research to develop treatments for chronic diseases, the NIH have funded numerous behavioral interventions to prevent chronic diseases across the pediatric and adult populations.
And medical leaders in America have been discussing different approaches to tackle chronic disease for a very long time. There was even a seven-year project in the 1940s and 50s called The Commission on Chronic Illness, established through a collaboration between the American Medical Association, the American Public Health Association and the American Public Welfare Association.
It’s also not new to suggest that poor diet is a major cause of chronic disease, including the high prevalence of obesity and diabetes. A published review of dozens of studies from 2009 to 2023 in the British Medical Journal demonstrates the association between daily exposure to ultra-processed foods and chronic disease.
Furthermore, for years federal government agencies have been putting forward plans that emphasize the importance of improving nutrition and boosting exercise levels to combat chronic illnesses. In fact, the General Accounting Office published a report in August 2021 identifying 200 such efforts related to healthier food and increased physical activity. The GAO categorized the work being done into four rubrics, including research, education and messaging, food assistance and access, and regulatory action.
The report states that “poor diet is recognized as a prominent risk factor for developing a chronic health condition, alongside insufficient physical activity and a range of other important factors.” It goes on to say that “diet is related to chronic health conditions, including cardiovascular diseases, cancer, diabetes, and obesity.”
Dietary Guidelines Since 1980
National dietary guidelines were first published by the Carter administration in 1980, 60 years after the federal government started providing nutrition advice for the public through bulletins, posters, brochures, books, and—more recently—websites and social media. From around 1920 until 1980, dietary guidance included informing the public about the pyramid of food groups in a healthy diet, as well as food safety and storage, and recommendations on the need for sufficient mineral and vitamin intake to prevent certain diseases.
The first publication of the Dietary Guidelines for Americans was released in 1980. Since then, the Dietary Guidelines have become a cornerstone of federal food and nutrition guidance, which set the terms for school meals and government-assisted food programs.
Fast forward 30 years, when former First Lady Michelle Obama led a program called “Let’s Move,” which was aimed at curbing childhood obesity. President Barack Obama had established a Task Force on Childhood Obesity in 2010, with the lofty goal of solving the problem of childhood obesity within a generation. He announced the First Lady’s role in leading a national public awareness effort to improve the health of children with dietary and exercise guidance. Obama stated: “To meet our goal, we must accelerate implementation of successful strategies that will prevent and combat obesity. Such strategies include updating child nutrition policies in a way that addresses the best available scientific information, ensuring access to healthy, affordable food in schools and communities, as well as increasing physical activity.”
But subsequent to Obama’s departure, the first Trump administration ushered in changes that restricted the nutritional science that could be used to update the U.S. dietary guidelines. It deemed off limits, for instance any discussion by the guidelines committee of red and processed meat, sodium and ultra-processed foods and their impact on the environment.
Trump’s track record during his first administration ran counter to RFK Jr.’s Make America Healthy Again priorities. For example, the Environmental Protection Agency reversed a ban on chlorpyrifos, a pesticide widely used on farms which has been linked to neurological problems in children.
Additionally, the administration reversed efforts to make school lunches healthier and cut food assistance programs by billions of dollars, rolling back rules adopted under President Obama that mandated more wholegrain foods, as well as fruit and vegetables in school meals.
The Biden administration brought back several Obama-era actions, while convening the second White House Conference on Hunger, Nutrition, and Health in 2022, 50 years after the first was held. The administration soon began implementing a new national strategy for “ending hunger and increasing healthy eating and physical activity so fewer Americans experience diet-related diseases.”
After the first Trump administration left certain pesticides on the market, the Biden administration banned them. Further, it attempted to make school meals healthier and strengthened nutrition standards in the Special Supplemental Nutrition Program for Women, Infants, and Children program, while investing in local food systems and pursuing policies that combat agricultural industry consolidation.
And the Department of HHS hosted its first-ever “Food is Medicine” summit in January 2024, featuring stakeholders examining the intersection between food and health. HHS aims to cultivate an understanding of the relationship between nutrition and health, facilitate easier access to healthy food, particularly in under-resourced communities, and educate the public on which nourishment is essential for better health.
Now, with Trump’s second term in office underway, perhaps he has had a change of heart on things like the role of nutrition in health, as it’s clear he’s forging a very different path from the one he took from 2017 to 2021. Nevertheless, his MAHA Commission represents in many ways a continuation of something previous administrations have been pursuing for decades.
