There is no denying American health is in trouble. Forty percent of us are obese. More than seventy percent are overweight. America ranks last among comparable countries in life expectancy. Our maternal and infant mortality rate is among the highest of developed nations. More Americans report deep loneliness than ever. These are but a few of many scary statistics we could cite. On whole, Americans are not doing well.
This isn’t new. America has been trending toward worsening health for years. Both of us (Brad and Steve) remember sitting in class in college two decades ago discussing the same topics we are now: obesity, heart disease, life expectancy, diet, exercise, cancer, and so on.
But contrary to popular opinion, the country hasn’t just been sitting on its hands. Many world-class scientists and public health officials have been trying to do something for a long time. For example, the “exercise is medicine” movement was introduced in 2007 by the American College of Sports Medicine. Michelle Obama pushed a large initiative to minimize processed foods, improve school lunches, and get kids moving in 2010. Many states have attempted to institute taxes on sugar-sweetened beverages. Municipalities have overhauled their built environments to include more sidewalks, bike lanes, and parks to encourage physical activity. We’ve also seen the introduction of lifesaving vaccines, and recent breakthroughs in medications for cancer (immunotherapies) and even obesity (GLP-1 antagonists).
Many of these efforts have made a big difference. And yet, there’s no denying the health of our nation continues to decline. Which brings us to today.
A surge of interest has developed for improving the health of Americans. RFK Jr. coined the Make American Healthy Again (MAHA) campaign, and was recently nominated to be director of Health and Human Services, America’s biggest governmental health agency. Many of the top podcasts in America claim to be about health and wellbeing. The weekly lists of bestselling books almost always include those on nutrition and exercise.
We love when health and wellbeing take center stage. These topics comprise both of our academic backgrounds, and we’ve been appointed to teach and lecture on them at major universities.
Unfortunately, when these topics come up in the public discourse, we end up with a lot of showmanship and grift instead of substance. We get simple solutions to complex problems. Just look at nutrition, where we routinely shift from demonizing one nutrient to the next for the cause of our obesity epidemic. (It’s carbs, no fat, no sugar, no trans fats, no seed oils, no high-fructose corn syrup, and on and on). We also see the health grift on the internet, from secret supplements that we’re promised will fix our gut (with zero studies behind them), to cold plunges being sold as a weight loss supercharger, to all sorts of other elaborate kabuki that you can only get from the influencer who is telling you about it, or from their podcast’s sponsor.
These podcasters, influencers, and gurus are popular as ever, following in a long line that started with Dr. Mehmet Oz. But even so, America’s health continues to decline. Which makes you think that perhaps the root problems and solutions lie elsewhere.
We are about to get hit with a deluge of misinformation on health. Much of it will be fear-mongering. Some will have a hint of truth. Often, facts and data will be twisted as lifelong grifters take advantage of the complicated nature of research and a layperson’s (understandable) lack of knowledge of the minute details of a topic.
We expect to see the intensification of an ongoing cycle: bouncing from one trend or fear factor to the next. Once the nutrient/substance/idea that’s being demonized has gone out of vogue, the grift will move to the next. The cycle is fueled by fear and misinformation. The result is the capture of our attention (which is almost always monetized) and, in some cases, our money. This is true whether it’s the vaccines cause autism myth; the latest and greatest supplement; or the seed oils are one of the biggest health concerns in the world proposition; which, of course, is absurd.
There is a difference between people who use health, longevity, and wellbeing primarily to grow a podcast or their fame, and people who actually want to make a dent in these important topics.
Before we dive into what the evidence shows is most important for making America healthy again, we want to give credit to the MAHA movement. America probably shouldn’t have cereals and other processed foods with an ingredient list three times as long as in Europe. We would welcome regulations in the style of Europe that require an ingredient to be shown to be safe before using it as an additive. But that European model doesn’t immediately demonize all chemicals or additives; rather, it uses science to test what is safe or harmful. A similar approach in America would be great.
We’d also welcome policies that would regulate ultra-processed foods, especially if these were considered in conjunction with subsidies for more satiating and nutritious options. The problem with the MAHA movement is that it combines good ideas (e.g., less processed food) with ones that lack any scientific justification or worse, that could be extremely harmful to society (e.g., creating unsubstantiated fear around vaccination and autism).
If we actually want to make America healthy again, here are 11 principles to guide the path:
1. The social determinants of health matter. A lot. In particular, we need policies and incentives to build more housing so that the cost of stable and desirable living spaces declines. Other social determinants of health include poverty, education, access to healthcare, access to food, and safety. A quick look at differential life-expectancies across US counties shows it is far more complex than seed oils or greens supplements.
2. Vaccines should continue to be tested for safety and efficacy in large trials, and when they are safe and effective, they should be used widely. Vaccination has reduced more human suffering and death than any other technology outside of sewage and sanitation. We have an incredibly large analysis of data on childhood vaccines that have routinely found them to be effective and safe.
3. Overweight and obesity are serious concerns. Excess body fat is associated with increased mortality (death) and morbidity (disease). Two things can be true at once: we should not judge or stigmatize people who are overweight or obese (nearly 3/4 of Americans) and we should enact tactics to reverse overweight and obesity, including medication, lifestyle interventions, and food policy. You can love yourself at the same time as wanting to reduce body fat.
4. Ultra-processed foods (UPFs)—those with added fats, sodium, and/or sugars—are not good for health and well-being. It is unlikely that any government policy will reduce the universality of UPFs (this would require eliminating fast food establishments, convenience stores, and gas station food, for example) but we can and should start somewhere, such as overhauling school lunches. (Michelle Obama attempted to do this in 2010 and was stopped by Republican politicians who were in the pocket of big food and who screamed, “It’s an encroachment on our freedom!” This was dumb then and it’s dumb now.) We should not demonize specific nutrients—sugar is the problem; no fat is the problem; no carbohydrates are the problem—and instead focus on the harms and ubiquity of ultra-processed foods.
5. Physical activity is the single most effective behavioral intervention for physical and mental health. Physical activity should be prioritized in the school system in the same way that literacy is. This is not about sport performance or body type, it’s about instilling the value of movement for everyone starting at a young age. For adults, we can’t just tell people to move more often. We need to make it easier. This includes bike lanes, sidewalks, parks, and so on to give people easier access movement. We need to look at gym memberships, personal trainers, and coaches as preventative interventions. We need to increase run clubs and fitness groups in parks.
6. Loneliness and isolation are terrible for physical health, mental health, and civil society. Modern society has replaced genuine community with the illusion of connection. We look for our tribe online instead of in the real world, leading to what Sherry Turkle calls being along together. The best thing many people could do for their health is trade listening to a three-hour podcast for coffee with a friend. We need to create more spaces for genuine connection. For as hard as we’ve been on the cold plunge fad (and for good reason), there’s a cold-plunge place where Brad lives in Asheville that he thinks is a great idea. Why? Because it’s communal—people put away their phones and get freezing and then hot together, laughing, talking, and bonding with their neighbors. This is the real benefit of something like a cold-plunge, dating all the way back to ancient Greece. It’s not doing it alone on your back deck at 5AM and recording yourself for instagram. The same goes for just about every other “wellness” trend. Be it religious institutions, bowling leagues, run clubs, board game nights, book clubs, or countless other possibilities, we need more local opportunities to build genuine and durable belonging into our lives.
7. Access to health care is important, but we cannot expect doctors to fix all that ails us. Health insurance should cover preventative and acute interventions that are proven to reduce human suffering, but not elective, cosmetic, or anecdotal care.
8. Medical training should not be a place where young people go to get depressed. The current medical training program was created by a maniac who was addicted to cocaine. It’s time for an overhaul. Yes, being a doctor is hard. And yes, it is perhaps the most serious craft to master. But there are ways to make it more sustainable. At the same time, we should not baby trainees on culture war issues. Medical training ought to be similar to becoming a pro athlete: an arduous and meaningful journey without bullshit and filled with honor, mutual respect, and appropriate rest and renewal.
9. Educate people on the potential benefits and harms of new health trends, such as continuous glucose monitors, sleep scores, full-body MRIs, and supplements. What currently happens is these products and services are presented by people who have money to make on them and therefore only potential benefits are mentioned. But there are also plenty of potential harms, such as poor validity, obsessive tracking leading to worse outcomes, incidental findings, and wasting time and money.
10. Prioritize clean air and water. Most of us can remember the tragedy of Flint Michigan having lead in their water a few years ago. Well, a 2016 survey of local water by Reuters found that over 3,000 areas in the U.S. have higher lead levels than the crisis in Flint. A 2018 study in the Lancet found that lead exposure may be leading to hundreds of thousands of deaths per year.
The point is simple: We don’t need to create controversies over ‘toxins’ that likely aren’t really toxic. We have substances in our air and water that we know cause problems. Why not tackle those? (The answer traces itself back to principle number one: generally, poor water is found in poor areas, and poor areas don’t get the resources they need.) That doesn’t mean we ignore other chemicals. But we should let research drive our priorities instead creating a new boogeyman every few years to continue the attention grabbing grift.
11. Call out lies and bullshit loudly, whether they are coming from the right or left. There are not 75 childhood vaccines. In fact, vaccines are easier on our immune system now, as we use 10% of the total antigens we used 30 years ago. Body fatness is not a cultural construction of the patriarchy; it is a biological process that increases the chance of disease and early death. A cold plunge does not have substantial health benefits beyond the community in which you do it. There is no single nutrient that is killing us and there is no single diet that will save us. The more outrageous and enticing the claim, the more attention it gets, and the more someone makes money. But if we are to actually make America healthy again, it cannot be fueled by a marketing grift.
At The Growth Equation, our mission is to be a signal amidst the noise. It’s to provide you evidence-based insights that have been validated by actual science and that have proven results in the real world, along with habits and practices that can actually help you live and perform better.
In the coming months, we are going to do our best to separate the wheat from the chaff and look at what actually matters when it comes to health. We’re largely going to focus on the individual, because we want you to walk away with actionable advice you can apply in your own life, but when appropriate we’ll mention society-wide issues too.
This above list is not exhaustive and our analysis is just one of many possible good ones. The point is that if we are going to have a national conversation about making America healthy again, we should be rigorous in how we do it.
P.s., Over the next four years, the number of bad ideas and misinformation about health and performance are bound to spread like wild. If you’re a serious person who wants to cut through the bullshit, be sure to subscribe to our newsletter, where we’re committed to always delivering you the truth.
