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Peter W. Stevenson /The Washington Post via Getty Images
How RFK Jr. could reverse our nation’s foolish approach to obesity
Dec 12, 2024
The river was swift and unrelenting, its currents carrying victim after victim downstream. Local villagers responded by stringing nets across the water to prevent further drownings. Yet, despite their efforts, the death toll continued to rise.
Eventually, a newcomer to the village asked a simple yet critical question: “Why are people falling into the river in the first place?” Following the water upstream, the villagers discovered the source of the problem: a crumbling bridge sending person after person into the rapids.
This “upstream parable” illustrates the folly of America’s response to obesity.
Like the villagers, Americans have relied on reactive, downstream solutions to combat the problem. Most recently, political and public health officials have touted weight loss drugs like Ozempic and Wegovy as the solution. While these medications help people lose significant weight, they don’t address the reason people become obese in the first place.
Enter Robert F. Kennedy Jr., the controversial nominee for secretary of health and human services. While his nomination raises serious questions, it also offers a rare opportunity to confront the drivers of the obesity epidemic.
Obesity: Why the root of the problem matters
Obesity rates in the U.S. have surged over the past 30 years. According to The Lancet, the percentage of adults classified as overweight or obese has more than doubled to nearly half the population. Among adolescents, obesity rates tripled in the same period.
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But the health consequences extend beyond weight gain. Obesity is a major driver of both diabetes and cardiovascular disease, and contributes to 50 percent of cancer deaths, according to the American Cancer Society.
While medical organizations acknowledge that many factors contribute to obesity, public health leaders increasingly describe it as a genetic and biological disease. But these factors could not possibly double obesity in just 30 years — human DNA evolves over millennia, not decades. This focus on biology — and on medical treatments like drugs and surgery — obscures the epidemic’s root cause.
The primary culprit isthe food industry, which deliberately manufactures and markets ultra-processed, calorie-dense products packed with refined sugars and unhealthy fats.
Of course, genetics do play a role. The FTO gene, which increases susceptibility to overeating, helped early humans survive food shortages by encouraging calorie storage during times of abundance. In our modern era, the food industry has exploited this evolutionary holdover by engineering foods that trigger dopamine in the brain, driving addiction-like behaviors and overconsumption.
The result is a population increasingly dependent on nutrient-poor, high-calorie foods. Today, 42 percent of U.S. adults are obese, costing the health care system $173 billion annually.
While GLP-1 weight-loss drugs offer effective treatment for those already struggling with obesity, they require lifelong use to maintain results. More than eight in 10 patients discontinue these medications within two years, and the drug’s annual cost — exceeding $10,000 per person — places immense strain on patients and payors, and may soon hit Medicare’s budget, too.
Without changes to food manufacturing and marketing, the chronic disease crisis — which is responsible for 30 percent to 50 percent of preventable heart attacks, strokes, kidney failures and cancers — will only worsen.
Robert F. Kennedy Jr.: A controversial hope
Kennedy., awaiting Senate approval as President-elect Donald Trump’s pick for HHS secretary, is a polarizing figure. His promotion ofdebunked theories — like vaccines causing autism orCovid-19 targeting specific racial groups —raises serious concerns. Still, if confirmed, Kennedy could push for aggressive reforms that target the root causes of obesity, a step none of his predecessors have taken.
Kennedy has been outspoken in his criticism of the Food and Drug Administration, accusing the agency of suppressing access to products that “advance[s] human health but can’t be patented by” pharmaceutical companies. He has also voiced opposition to the widespread use of GLP-1 weight-loss drugs, describing them as a shortsighted approach to combating obesity.
Looking to the past for cures
Kennedy has promised to confront the food industry and revive America’s health, but the question remains: How might he achieve these ambitious goals? History offers a two-part blueprint: prohibition and taxation.
In the 1970s, research linked lead in gasoline to severe neurological damage in children. In response, the Environmental Protection Agency phased out leaded gasoline, reducing lead levels in children by over 90 percent. Similarly, eliminating lead in paint and pipes demonstrated how regulatory prohibitions can drive significant public health improvements.
More recently, local governments in cities like Berkeley, California, and Philadelphia implemented soda taxes to curb sugary beverage consumption, cutting sales by as much as 38 percent. Despite resistance and heavy lobbying from the beverage industry, these measures highlight how financial disincentives can effectively encourage healthier choices.
The sensible path forward
As long as high-calorie, processed foods dominate grocery stores, school cafeterias and restaurant menus, the nation’s health will remain in crisis.
Taxation offers a logical solution. If sugar- and fat-laden products contribute to hundreds of billions in health care costs, those expenses should be reflected in their prices. Revenue from these taxes, coupled with future savings from reduced obesity-related health care spending, could subsidize healthier food options for low-income families.
This dual approach — discouraging harmful choices while promoting affordable, nutritious alternatives — has the potential to reshape America’s food landscape and improve public health for generations to come.
If RFK Jr.’s nomination is confirmed and he chooses to target the food industry, he may garner bipartisan support. Democrats have long championed nutritional improvements for disadvantaged families, while Republicans seek reforms that reduce health care spending.
The time has come to move upstream — to repair the crumbling bridge of American health rather than relying on the safety nets of surgery and drugs. The next HHS secretary will face significant resistance from the food industry in pursuing this course, but courageous leadership can turn the tide of the obesity epidemic and deliver a stronger, healthier future for our nation.
Pearl, the author of “ChatGPT, MD,” teaches at both the Stanford University School of Medicine and the Stanford Graduate School of Business. He is a former CEO of The Permanente Medical Group.
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Hundreds of supporters of trans rights rallied outside the Supreme Court on Dec. 4. The court will consider a case determining whether bans on gender-affirming care for children are unconstitutional.
Marvin Joseph/The Washington Post via Getty Images
Supreme Court ruling on trans care is literally life or death for teens
Dec 12, 2024
Last month, the Supreme Court heard arguments on whether banning essential health care for trans youth is constitutional. What the justices (and lawmakers in many states) probably don’t realize is that they’re putting teenage lives at risk when they increase anti-trans measures. A recent report linked anti-transgender laws to increased teen suicide attempts among trans and gender-expansive youth.
In some cases, attempted suicide rates increased by an astonishing 72 percent.
This is an alarming trend in a nation poised to pass even more anti-trans laws, in a country already struggling with an all-time high suicide rate.
As a youth mental health expert, I urge our lawmakers to resist pressure for more anti-trans laws. As responsible adults, we need to protect our children — all children — from increasing suicide rates by adopting policies and programs known to prevent suicide, not only among trans and gender expansive teens, but among all young people.
Suicide is Preventable
Every suicide is tragic. The decision of a child — any child — to die by suicide is shattering. It is also preventable, and adults have a responsibility to protect children from problems with known solutions.
Even though suicides are preventable, youth suicide rates have grown a staggering 62 percent in just the past few years.
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We also know that specific measures can help reduce suicide among LGBTQ+ teens in their schools: for instance, student-led organizations known as gay-straight alliances are associated with lower rates of suicidal thoughts and behaviors. Importantly, school health policies that supported LGBTQ+ youth also improved suicidal thoughts and behaviors among heterosexual students. By helping one group of teens, we help all teens.
Young people are eager for solutions where they can normalize conversations about mental health while showing up for themselves and their peers. Research shows suicide rates drop for teens when these particular measures are implemented. For example, Sources of Strength is an evidence- and school-based suicide prevention program that uses a peer leaders model. Through support and training, peer leaders normalize discussions and coping strategies around mental health and ensure their peers know where to turn when they need additional support. In a study with 18 high schools, training peer leaders in Sources of Support led to significant improvements in students’ perceptions that adults in school would be able to provide help and that it was acceptable to seek help when experiencing suicidal thoughts and behaviors. This program creates a safe and supportive environment with people to turn to.
Teen Suicide Linked to Anti-Trans Laws
In the past few years, more than half of U.S. states have passed anti-trans laws. These laws range from restricting access to gender-affirming care to banning use of bathrooms that match people’s gender identity to allowing or even requiring misgendering of transgender students. Meanwhile, the ACLU is tracking another 532 anti-LGBTQ bills proposed this year.
These laws do enormous damage to the young people they target. Last month’s report, published in the highly ranked journal Nature Human Behavior studied suicide rates in 19 states after the passage of anti-trans laws. Researchers found that in the first year after a state enacted anti-trans laws, teen suicide rates increased significantly, compared to states that did not pass such laws. Two years after anti-trans laws were passed, suicide attempts increased for trans and nonbinary teens in affected states by between 7 percent and 72 percent.
Behind these numbers are teens who are scared for their lives — the approximately 300,000 trans and gender expansive teens between the ages of 13 and 17. With one in four U.S.high school students identifying as LGBTQ+, it is unconscionable to pass legislation proven to increase suicides among their community.
Instead of legislation that criminalizes young people and their families for living their lives, the rise in young people who identify as LGBTQ+ should highlight the need to eliminate barriers to safety, social acceptance and appropriate care as well as focus on education and professional development reflecting the unique needs of LGBTQ+ youth.
Adults Have a Moral Obligation to Take Action
Clear research suggests steps that can save children’s lives. As adults and lawmakers, we have a moral responsibility to do that. Instead, anti-trans laws lead teens to feel their only option is suicide.
To be sure, some well-meaning voters, knowing adolescence is a key developmental period for identity formation, may believe they are protecting children and their caregivers by limiting the discussions about one’s sexual or gender identity in schools. They may think even talking about trans and gender-expansive identities introduces young people to an idea they may never have adopted on their own (although gender diversity has been around for centuries) — or one that they may later regret.
However, this is not the case. Although not all trans people seek gender-affirming care, most do and the research shows “trans regret” from gender-affirming surgery is rare or nonexistent. In fact, it is significantly more rare than regret for elective surgeries among the broader population such as facial reconstruction or chest surgery. What we do know is gender-affirming care, including affirmative counseling, is an unimpulsive and informed process that improves the quality of life for trans youth. Gender-affirming care is suicide prevention care.
It’s possible politicians misunderstand the science and believe they’re protecting young people. Even so, they are reaping political gain and media attention by essentially dehumanizing young people, preventing them from safely living their lives authentically and with dignity. As these bills proliferated among states, so did abhorrent rhetoric and threats to the lives of trans people. In states with anti-LGBTQ legislation, school hate crimes quadrupled. What people don’t know or understand, they fear. And we now know that fear can manifest into hate, leading to the death of young people on our watch.
Our children deserve better. We must create safe and supportive communities where young people are seen, supported and recognized for who they are. All children are human and deserve validation and affirmation. No matter your personal belief, we can and must all agree that saving children’s lives — all children’s lives — transcends everything.
Fernandes is an assistant clinical professor at the Child Study Center at the Yale School of Medicine and director of research and evaluation at Lady Gaga’s Born This Way Foundation. She is a public voices fellow of The OpEd Project.
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Civil discourse can be effective, but its effectiveness is limited.
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The 4 R’s reduce dialogue workshop effectiveness – but don’t despair
Dec 12, 2024
In some circles, reducing political divides and civil discourse are almost synonymous. I’ve had conversations where I mention that I work on reducing these divides, only to have the other person launch into some story or opinion about civil discourse.
By “civil discourse,” I mean an interpersonal focus on communication, which can include activities like dialogue or certain types of debates.
Groups interested in reducing political divides have largely embraced this interpersonal civil discourse model as the primary method, in part because the start-up costs of holding a dialogue are low. Many of the 500-plus members of the #ListenFirst Coalition are clear examples of this approach. (Note: the organization I run and co-founded, More Like US, is a coalition member.) As I have seen since 2017, when I attended my first Braver Angels (then Better Angels) workshop, there has often been a default to a small-group format to teach skills and/or practice engaging in civil discourse.
Civil discourse can be excellent and effective, but organizations involved need to be aware of its numerous drawbacks that limit its capacity for scale. When this space is internally honest about civil discourse’s limitations, it can better choose methods that are most likely to succeed. Civil discourse should always be part of some efforts, but the space should be open to a wider array of approaches.
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I summarize civil discourse’s limitations, especially in the context of small-group formats, with what I will call the 4 R’s: recruitment, reliability, representativenes, and repetition. Explained more below, the briefest overview is that it is difficult to get many people to attend events (recruitment), civil discourse is not inherently effective (reliability), even a successful 1:1 interaction may not generalize to the entire out-party (representativeness) and getting people to repeatedly use skills learned is challenging (repetition). These form a kind of narrowing funnel, where the likelihood of many individuals achieving long-lasting change gets smaller and smaller with every step.
Recruitment: People need to have a substantial amount of time, interest and energy to attend an event. At least with Braver Angels, participants have been disproportionately older and with high educational attainment, people who more likely fit those criteria. Braver Angels should be commended for bravely collecting and releasing this data; most other discourse-based groups likely have broadly similar demographics, aside from groups focused on Gen Z like BridgeUSA. Separately, it also takes substantial effort to plan even a single event. The numbers to achieve scale via events seem unrealistic: Even if 100 events could each reach 10 people per day, it would take over 400 years to reach all voters in the most recent presidential election. Affective (emotional) polarization is widespread among the public, so simply reaching a sliver of the population in a shorter amount of time will likely have limited impact.
While at least one other field has embraced research showing 3.5 percent of the public needs to be reached, citing findings about the number of citizens literally needing to be in the streets to overthrow a dictator, the research has questionable relevance to civil discourse efforts. Simply attending a workshop does not imply full participation in a movement, and the goals of civil discourse workshops are obviously very different than trying to overthrow a dictator.
Reliability: Gordon Allport’s original Intergroup Contact Theory from 1954 identified four highly restrictive conditions for optimal contact: “equal group status within the situation, common goals, intergroup cooperation and authority support.” While more recent research shows that these conditions are more helpful than absolutely necessary, successful conversations still are not inevitable.
Representativeness: Even if a conversation is successful, the conversation partner may not be seen as particularly representative of the other political party as whole. In the academic literature, researchers find this “primary transfer effect” from the individual member to the group requires that “some level of group representativeness must be maintained for attitudes to generalize to the whole group.” Those attending workshops are a self-selected group, and the demographics can quite wildly differ from the larger target population. For instance, using Braver Angels data from 2020-2021, we see that 65 percent of participants had postgraduate degrees, compared with less than 15 percent of the overall population aged 25 and older. These conversations still can have a benefit of showing there are “good ones” across the political spectrum, but they do not necessarily change views about those across the political spectrum en masse.
Repetition: A few hours at a workshop may feel like an oasis, but then messages in the real world spew political negativity and division. Braver Angels’ transparency on this front is again admirable, including academic research showing that explicit measures of reduced affective polarization (e.g., via feeling thermometer, trust measure, comfort with those in the other party in various social situations) were not statistically significant after one or two weeks after participating in a day-long red/blue workshop among undergrads at four universities. Improvements on an Implicit Association Test were still statistically significant at that timeframe, but not after six months; willingness to donate to a depolarization group focused on Gen Z remained elevated throughout. Thus, it appears necessary to have repetition to depolarize in this context, but many will not want to attend multiple events, or they may have difficulty finding appropriate repeat conversation partners.
The 4 R's are not meant to chastise or induce hopelessness among those interested in the future of the country. Instead, they are a call for reflection and reconsideration of the best tactics for the space to take, given these limitations.
In part two of the article, publishing tomorrow, I will cover some suggestions (with 4 S’s) for how to still use dialogue in specific circumstances, and when opportunities besides dialogue may be best.
Coan is the co-founder and executive director of More Like US. Coan can be contacted at james@morelikeus.org
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A reckoning for the pro-democracy community
Dec 12, 2024
In the wake of former President Donald Trump’s re-election to the White House and the surprising margins of his victory, reckonings abound — not just for the Democratic Party, the future of identity politics, celebrity culture, and elites, but also for a newer faction: the pro-democracy community.
The pro-democracy community, nebulously defined as it is, has been growing, especially since Trump’s first victory in 2016. Its goals intend to be nonpartisan, and focus on strengthening civic participation, reforming democratic institutions, and improving civic culture. Examples of field members include organizations promoting civics education, those advocating for ranked-choice voting, and those attempting to address polarization through bridge-building initiatives — all vital cogs in an American democracy that needs repair.
Yet today, this pro-democracy movement desperately needs to reassess its strategies and tactics. A vision of strengthening and revitalizing the nation’s civic fabric remains essential, regardless of who wins the presidential election. However, the popular vote seems to indicate that the majority of American voters repudiated the Democratic message that Trump is a threat to democracy at best and a potential dictator at worst.
I joined the pro-democracy ranks when I co-founded a civics education nonprofit in 2009, Generation Citizen. The organization aimed to foster active and engaged citizens by re-embedding civics education in the K-12 school curriculum, but it was incredibly difficult to get anyone to take us seriously for the first seven years. One prominent education leader told me that our best strategy would be to get students to focus on international issues — that democracy was secure and stable state-side. So went the orthodoxy with President Obama at the helm.
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Everything changed in 2016. All of a sudden, civics education was the most popular intervention in town; our budget grew from just under $1 million to over $4 million in a year, and funders pushed us to expand into rural communities. Simultaneously, the pro-democracy community gained traction. Funders and organizations recognized that an American democracy we took for granted might be eroding and that investing in a more-engaged citizenry could lead to the end of Trump and his politics. But the reasoning warrants reflection: The foundations of democracy were weakening long before Trump’s election, and the fact that it took his election to bolster the community suggests that the community is more invested in preventing Trump’s power than deepening civic culture and institutions.
I moved on from Generation Citizen at the end of 2020, proud of my leadership, but tired and burnt out. I wanted to successfully transition the organization to new leadership and engage in new kinds of democracy work. I landed at the Stavros Niarchos Foundation Agora Institute at Johns Hopkins University, a center dedicated to strengthening global democracy through powerful civic engagement and informed, inclusive dialogue. In early 2022, I organized a bipartisan, off-the-record convening of democracy advocates, eager to determine what was and wasn’t working in the sector. While the conversation was candid, and led to future collaboration, several participants later shared the same explicit feedback: The room was about 90 percent progressive, and if we were serious about revitalizing democracy, we needed more conservative voices.
With that perspective in hand, I collaborated with the center-right think tank R Street Institute to design a conservative agenda for democracy initiative. Over the next two years, we convened hundreds of Republicans across the United States with the aim of strengthening democratic institutions in the long-term, and exploring ways to rebuild trust in elections as a short-term goal.
Many people on the opposite side of the political spectrum reacted with shock (“Pro-democracy conservatives exist?”) and judgment (“You’re working with Republicans?”), but the project has been both rewarding and important. I traveled across purple states like Wisconsin, Arizona, and Georgia, and deep-red states like Wyoming, Idaho, and Kansas, and learned from Republicans who were worried about the state of the republic, who believed that Joe Biden won the 2020 election, and who were still proudly conservative in their political ideology, if worried about the state of their party. I continue to believe that a true, functioning democracy requires functional political parties and that the Republicans I met are essential to making that happen.
Today, rather than pursuing the same anti-Trump agenda that motivated the pro-democracy community in 2016, the community needs to reckon with the fact that Trump, his policies, and his rhetoric, have not been repudiated, but rather, embraced by many. To that end, it’s imperative that the field approaches its work with deep humility and introspection. In that spirit and without presuming to have the answers, here are four recommendations I believe can aid the process and ultimately yield better results.
1. Listen before acting. This may seem trite in the aftermath of the election, but the pro-democracy community needs to wake up to the fact that its strategy isn’t working. Yes, many young people are receiving civics education, many Americans are participating in efforts to reduce polarization, and many communities are working together to solve problems at the local level. But election denialism endures on both sides of the aisle, polarization is deepening, and institutional trust continues to plummet.
In 2016, numerous new organizations devoted to safeguarding democratic guardrails, convincing Americans to run for office, and advocating for electoral reform popped up to address an explicit challenge: Trump. This time around, the challenge is trickier: Americans are demonstrating a lack of faith in democracy. Rather than leaping to action and creating siloed solutions, we need to stop and listen to people on the ground. We should attempt to really understand how people from all political ideologies are currently thinking about democracy rather than quickly designing solutions.
2. Call balls and strikes. Because former President Trump is a Republican, and he and his party have objectively led the most outlandish challenges against democratic norms, opponents are naturally inclined to align with the Democratic Party. President Joe Biden’s declaration that “democracy is on the ballot,” which Democrats around the United States echoed, made this explicit.
Yet to maintain and grow its credibility, the pro-democracy community can’t fully align with the Democratic Party. Indeed, without casting an equivalency to denying election results and inciting insurrections, the Democratic Party has engaged in its fair share of questionable behavior.
It is incumbent on the pro-democracy community to call out whenever behavior and rhetoric violates democratic norms, irrespective of which political party is involved. For example, in 2021, President Biden called Georgia elections bill, SB 202, “Jim Crow 2.0” because of its voter suppression goals. Evidence shows that the bill has led to increased turnout and trust, with 98.9% of voters in the 2022 midterm elections reporting no issues casting a ballot, and 95.3% reporting a wait time of less than 30 minutes. Meanwhile, across the country, Democrats have propped up election-denying candidates in primaries in an effort to give their candidates a better shot in the general election. The pro-democracy community should have called out the irresponsible rhetoric surrounding the Georgia bill, and it should criticize Democrats for engaging in electioneering counter to basic democratic principles.
Calling out the violation of constitutional norms that threaten American democracy will remain important in the new Trump era, but it will be critical for the community to distinguish between potentially harmful policies and actions that actually do curtail these norms. This will be incredibly challenging. But there is a difference between massive deportations, which are by all accounts legal, and ending birthright citizenship, which wouldn’t be constitutional. The pro-democracy community needs to be careful about when it is associating policies it doesn’t like with democracy, as opposed to behavior that actually challenges democratic principles.
3. Diversify the ranks. Along similar lines, the progressive bent of the pro-democracy community has contributed to an excessive amount of group-think, with like-minded organizations talking to each other about ways to address the lack of faith in democracy among individuals with whom they rarely interact. For example, it often relies on research and polling to explore the best ways to talk to conservatives about democracy issues.
The doctrine that organizations shouldn’t design interventions without involving the people impacted by them is foundational to international development. Yet when it comes to US democracy, organizations are often attempting to persuade people who are less trusting of democracy without actually engaging with them.
It may be uncomfortable, but the pro-democracy community needs to diversify its ranks to include conservatives and individuals who cast their vote for Trump.
4. Get local. The most impactful way to engage with politics is at the local level. But unfortunately, the local has become national. Too many in the pro-democracy community focus all of their work on the federal level, without engaging at the state and city level.
Whereas it can seem like the federal space can be a depressing partisan morass, there’s exciting work happening at the local level. Organizations like the Trust for Civic Life are finding and funding work to connect individuals and civic infrastructure in the Appalachian region of Kentucky, allowing them to collectively rebuild after the 2022 area floods, and building civic agriculture in northern Michigan . The city of Bend, Oregon has engaged in a citizen assembly to explore community approaches to addressing homelessness, and cities like Boston are using participatory budgeting to allow citizen input into how to spend public dollars. Democracy is being renewed and reinvigorated at the local level.
To say that the solution to America’s problems lie in its communities is cliché. But one way for advocates to address challenges to democracy is to organize and get involved in local politics themselves. The process can bring both a sense of perspective and a needed respite from national work.
While these approaches aren’t solutions in their own right, they provide some starting points for effective action. My hope is that the pro-democracy community can meet this unprecedented moment with humility and introspection, rather than silver bullet solutions. The 2016 playbook won’t work in 2024. It’s time to listen first.
Warren is a fellow at the SNF Agora Institute at Johns Hopkins University. He is co-leading a trans-partisan effort to protect the basic parameters, rules, and institutions of the American republic, and is the co-founder of Generation Citizen, a national civics education organization.
This article was first published in the Stanford Social Innovation Review. Read the original article.
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