“COVID-19 killed 100,000 Americans in just four months — a devastating tragedy of epic proportions. And, in just the last four months, poor diet has caused an estimated 107,000 U.S. deaths from cardiovascular diseases and diabetes, and 80,000 new cases of cancer. Half of U.S. adults have diabetes or prediabetes. It is also a devastating tragedy of epic proportions,” says one of the coauthors, Dariush Mozaffarian, MD, DrPh, MPH, a cardiologist and the dean of the Friedman School of Nutrition Science and Policy at Tufts University in Boston. Dr. Mozaffarian is a member of the aforementioned panel, called the Federal Nutrition Research Advisory Group. The strain that diet-related illnesses put on the U.S. healthcare system and government budgets has been further exposed and worsened by the COVID-19 pandemic, according to the paper, published on July 20 in the American Journal of Clinical Nutrition. In the past 50 years, federal healthcare spending has grown from 5 to 28 percent of the federal budget, with 85 percent of that spending on the management of diet-related chronic diseases. The lack of good nutrition also poses a growing threat to America’s military readiness as well as its ability to stay economically competitive in the world, according to the group; nearly three in four people between ages 17 and 24 do not qualify for military service, with obesity being the leading medical disqualifier.

Good Nutrition Is Essential for Overall Health

Close to 46 percent of adults and 56 percent of children in the United States have an overall poor-quality diet, according to the paper. These figures are troubling because of the critical role nutrition plays in health, says Elizabeth Mayer-Davis, PhD, a distinguished professor of nutrition and medicine and chair of the department of nutrition at the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill. “What you eat affects every system in the body throughout your entire life span,” she says. Dr. Mayer-Davis is a board member of the American Society for Nutrition, a group that voted to support this white paper, but she was not part of the group of experts who wrote it. The field of nutrition has a very wide scope, which goes from basic science and molecular mechanisms and genetics all the way through policymaking and food recommendations, says Mayer-Davis. “Overlaid on all that is what influences what we eat. That happens as a consequence of each person’s culture, their family, their community, and what they like to eat, as well as what food they have access to and what they can afford,” she says. “Once you put all those pieces together you have a really complicated mix.” RELATED: Black People Are at Greatest Risk of Losing Food Assistance When It’s Tied to Work

The Majority of Americans Aren’t at a Healthy Weight

Nearly three in four American adults and nearly one in five children are now either overweight or obese, as measured by their body mass index (BMI), wrote the authors, citing data collected by the Centers for Disease Control and Prevention (CDC). “The epidemic of overweight and obesity drives a lot of health outcomes and impacts your risk for heart disease, [type 2] diabetes, and several different types of cancer, as well as orthopedic conditions,” says Mayer-Davis. Additional factors that increase the risk of developing a chronic disease include physical activity, alcohol use, smoking, and a family history of chronic disease, according to the CDC. Overweight and obesity are the result of too many calories consumed compared with the level of physical activity that people have, she says. “Over a long period of time there’s been an intake of not just too many calories in general, but of the types of food with a lot of added sugars and fats that are just adding calories without much nutritional value,” says Mayer-Davis. These types of foods include soda and other sugar sweetened beverages, cakes, cookies, doughnuts, and dairy desserts like ice cream, according to the National Institutes of Health (NIH). “We no longer live in a population that could be considered generally healthy with regard to weight; the majority of the population is overweight or obese and the minority of the population is of normal weight. That’s a huge problem and a public health crisis,” she says. RELATED: Despite More Dieting, Americans Still Aren’t Losing Weight

Nutrition Plays a Role in Health Disparities

“Figuring out how to better address nutrition in this country is a critical part of addressing the really significant healthcare inequities we have in this nation,” says Mayer-Davis. The paper outlines several challenges in this effort:

Food insecurity impacts 1 in 8 Americans and is expected to more than double this year due to the economic effects of COVID-19.The disparities in diet quality by race and ethnicity, education, and income continue to grow.Poor diet can lead to lower achievement in school, lost productivity at work, more out-of-pocket healthcare expenses, and increased risk of chronic disease.

“The role of diet in overweight and obesity and health equity turns out to be closely related. We need to improve the cost and availability of healthy food,” says Mayer-Davis. “In many places, the available and inexpensive foods are those foods that have added sugars and fats, compounding the problem for communities where people are at higher risk for conditions like overweight and obesity and diabetes,” she says. RELATED: More Americans Exceed 200 Pounds, but Fewer See a Need to Lose Weight

Confusion Around Which Foods Are Healthy Can Lead to Poor Nutrition

Part of the problem is that many Americans are confused about what’s healthy and what’s not, according to the advisory council. There can be a few reasons for that, says Mayer-Davis. “Sometimes a study can get a lot of media attention and it’s interpreted that a particular food or diet is the ‘magic bullet.’ This can cause people to focus too much on a certain issue and neglect other areas of their diet," she says. In some cases, confusion can arise when studies on certain foods appear to give conflicting results, says Mayer-Davis. A good example of that is whether milk is good for you, she says. As far back as the 1980s, nutrition experts recommended skim or low-fat milk over full fat or whole milk to avoid too much saturated fat and weight gain, according to Harvard Medical School. On the other hand, a past meta-analysis of 16 observational studies published in the European Journal of Nutrition found that in many cases, consuming high-fat dairy (including milk) was actually associated with a lower risk of obesity. We’re also learning more about how people can have different responses to the same foods, which can also influence findings and make them appear inconsistent, says Mayer-Davis. “By the time this information can get to the pubic it can look like, ‘Experts don’t know if this food is good or bad,’” she says. “People have to eat, and we have to make recommendations based on the best knowledge that we have, but it’s incomplete knowledge. There’s research that still needs to be done so that we can better understand these things,” says Mayer-Davis.

Collaboration and Greater Investment in Nutrition Research Needed

“The paper calls for a restructuring of federal funding streams and expansion of the nutrition agenda as ways to enhance research funding, which may lead to answers in terms of policies, programs, and medical treatment,” says Laura Caulfield, PhD, a professor at the Johns Hopkins Bloomberg School of Public Health in Baltimore. Currently, funding at the National Institutes of Health (NIH) is separated among different disease states, with nutrition- and diet-related funding making up a small piece of each institute’s budget, explains Dr. Caulfield. The authors propose improved coordination and communication within the NIH, along with greater investment in nutrition research that could lead to independent and synergistic benefits. The advisory group also calls for the creation of federal offices and programs in nutrition to help accelerate needed discoveries and disseminate findings. “Collaboration and more communication between these groups would allow us to put knowledge into practice a lot faster. This could help address many of the nutrition-related problems that we have, including health inequity,” says Mayer-Davis. “The reality is that there’s no one solution; all the different stakeholders need a way to work together, and this paper offers a few opportunities to help make that happen,” she says. RELATED: Why Are Healthy Eating Habits Important?

COVID-19 is a fast pandemic on top of a slow pandemic — one of diet-related poor metabolic health, including type 2 diabetes, obesity, and other conditions, Mozaffarian said in an interview published by TuftsNow. “These diet-related conditions greatly increase the risk of poor COVID-19 outcomes, including hospitalization and death. If we had a metabolically healthy population, all the evidence suggests COVID would have been much less severe, and we potentially would not have had to shut down the economy, shutter businesses and schools, and trigger many losses of jobs,” said Mozaffarian. Another important piece of this is that nutrition is crucial for a healthy immune system, says Mayer-Davis. “It’s possible that whether or not someone gets ill at all with COVID-19 may be a function of their weight status. We don’t know that yet, but we do know from research that nutrition is very important in immune function,” she says. Research has shown that people who are overweight or obese do not respond nearly as well to the flu vaccine, says Mayer-Davis. A study published in the Annals of the American Thoracic Society in November 2017 found that compared with vaccinated healthy-weight adults, vaccinated obese adults have twice the risk of influenza or influenza-like illness. “What’s happening right now with COVID-19 shows us yet another example of the importance of nutrition, and particularly the aspect of overweight and obesity in the population. It’s really creating tremendous problems and contributing to health inequity,” says Mayer-Davis. RELATED: How Obesity May Increase the Risk of COVID-19 Complications