As the pandemic began to unfold a year ago, a common question popped up: who is most at risk of complications from COVID-19? Over and over again, expert opinion and data showed that advanced age and pre-existing conditions, like hypertension, diabetes, and obesity, were major risk factors. In fact, nearly every article discussing risks for COVID-19 mortality has mentioned obesity as a risk factor. One meta-analysis found that patients with obesity had a nearly four-fold increased risk of dying from COVID-19.
As medical students, almost every time we learn of a disease process, from end stage renal disease to idiopathic intracranial hypertension, obesity is mentioned as a risk factor. We are shown the infamous set of maps that illustrate the gradual creep of obesity from less than 10% in most states in 1985 to rates greater than 30% in many states in 2010. We are reminded that over two-thirds of Americans are obese or overweight, and that this reality has staggering health and economic consequences. Obesity is responsible for at least 300,000 excess deaths annually – more than twice the number of deaths attributed to stroke. Experts estimate that obesity-related healthcare expenditures cost the U.S. $315.8 billion in 2010, a figure that increases annually.
Everyone in healthcare has heard the same set of facts many times over. We hand-wring while blaming the situation on patients' poor diets and lack of nutrition knowledge. Yet, very little time is spent discussing the true root of this reality.
Metabolic Disease and Corn Subsidies
This rise in metabolic disease has a clear connection to the increase in usage of corn byproducts in processed and fast foods that began in the 1980s. These byproducts, such as high fructose corn syrup (HFCS), maltodextrin, and cornstarch, are used to cheaply sweeten or modify the consistency of everything from sodas to canned fruit to salad dressing. This adds retail value without proportional increase in production cost, while furthering the trend of processed foods having less and less nutritional value. This has led to increased consumption of processed and fast foods – and with it, an increase in obesity. While there is conflicting evidence as to whether or not HFCS is worse than sucrose as a sweetener, there is no question that by adding HFCS and other additives to processed foods, food manufacturers can drive down the production cost of their products, contributing to their overconsumption.
This lucrative dynamic is financially supported by our government. The U.S. federal government spends roughly $20 billion per year on farm subsidies: approximately 60% go towards corn and other grains that are used predominantly in processed foods and as animal feed, while fruits and vegetables receive less than 1% of these subsidies. Because of the subsidies that corn and other similar crops receive, their byproducts are exceptionally cheap and incentivize food manufacturers to use them in place of other ingredients, resulting in food that is both cheap and heavily processed.
In addition to being processed for food additives, nearly 40% of corn is used as animal feed. Unless otherwise labeled, the vast majority of the meat that Americans eat comes from centralized animal feeding operations (CAFOs), also known as factory farms. In these CAFOs, the animals aren't fed their natural diets, but rather, corn and other grains because they are cheaper.
This seemingly smart economic practice results in cruelty for both animals and consumers. For example, cows, which evolved to eat a variety of grasses, experience digestive problems while on a diet of corn and are more prone to infection, requiring the use of antibiotics. Corn offers another financial incentive as the primary feed for cows: it allows them to grow and fatten the amount they would in four to five years in only one year. Furthermore, the fatty acid profile of grain fed beef is associated with greater inflammation and oxidative stress as compared to grass fed beef, along with greater fat content. Additionally, the financial factors result in Americans eating nearly twice the recommended amount of meat due to the artificially low prices conferred through CAFOs. Lastly, the use of corn as animal feed and other non-food related products results in the reduction in the number of people that an acre of corn can feed from 14 to three.
In short, corn subsidies are linked to over-sweetening and increased demand of low-nutrition foods, and increased demand for unhealthy, factory-farmed meat – all of which are linked to increased obesity and chronic illness. Yet, there exist negligible subsidies for fruits and vegetables, despite the USDA's recommendation that Americans eat roughly 50% of their diet in fruits and vegetables.
The difference between what the government recommends and what they support financially displays a clear dissonance. The result: the avoidable diet-related health issues of millions of Americans.
How Can We Address the Issue?
The government should ensure that subsidies reflect their own guidelines for a healthy diet – and the American Medical Association (AMA) can use its considerable lobbying power to convince lawmakers of this.
In 2019, the AMA spent over $20 million lobbying the federal government. In the past, the AMA has advocated for increased federal funding for community-based food programs and supported soda taxes to combat obesity. In 2018, the AMA passed a resolution stating they "will request that the federal government support SNAP initiatives to incentivize healthful foods and disincentivize or eliminate unhealthful foods." Given the multiple health crises in the U.S., the AMA must take their advocacy a step further and actively lobby the government to rethink agriculture subsidies in the Farm Bill. Dietary recommendations made by the medical establishment should be backed by policy – fruits and vegetables should be subsidized, not corn syrup, fast food, and meat. It's time to address the epidemic of obesity at the root. The AMA must act boldly to address a systemic cause of the nation's poor dietary landscape.
To the AMA: call on the federal government to rethink corn subsidies and reinvest in healthy produce. Our patients deserve food policy that allows them to follow their doctor's recommendations.
Ruhee Shah is a second-year medical student at the Icahn School of Medicine at Mount Sinai in New York City. She spends her days thinking about systems-level change in healthcare while studying for her boards. Dave Youssef is a first-year medical student at the Icahn School. He is passionate about food and cooking and their importance to living a healthy life.
The Link LonkMarch 23, 2021 at 12:00AM
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