At the end of September, the White House will host a Conference on Hunger, Nutrition and Health, the first such conference in more than 50 years. Its goal is to accelerate progress toward ending hunger, improving nutrition and physical activity, and reducing diet-related disease.
Given the ubiquity of contradictory and headline-grabbing information that can lead to confusion about what to eat or drink, progress on improving diets and the science underlying dietary recommendations is needed now more than ever. Take alcohol consumption. A 2021 news article reported that moderate alcohol consumption could benefit heart health. Eight months later, the same news organization reported that no amount of alcohol was beneficial for health. Examples of this sort of about-face in dietary advice abound; it’s no wonder many people are tempted to give up trying to follow dietary recommendations entirely.
To ensure that nutrition guidance and policies rest on a secure evidence base, nutrition research must be fully funded and optimally coordinated.
Nutrition science is evolving, with a rapidly growing collection of methods and interventions. At the time of the first White House nutrition conference, in 1969, research focused particularly on isolated vitamins and minerals and their role in nutrient deficiency diseases like rickets and pellagra. Since then, the focus has switched from underconsumption to overconsumption, and the United States, along with many other countries, is now experiencing epidemic levels of chronic diseases like cardiovascular disease and type 2 diabetes that are linked to energy imbalance and obesity. Focusing on the prevention of diet-related chronic diseases has produced important gains in knowledge, but it has not been sufficient to stem increasing rates of these conditions. The burden is not likely to lessen anytime soon and there is much that scientists still need to learn.
Yet federal research efforts remain uncoordinated and there is no official accounting of all federal nutrition research funding. Politico, a media company, conducted its own analysis and found that the share of federal research spending dedicated to nutrition at the National Institutes of Health and the U.S. Department of Agriculture has remained flat since the 1980s.
The NIH is the largest funder of nutrition research in the U.S.: it spent just over $2 billion on nutrition research in 2021 (though this included some projects that also addressed tobacco, exercise, and other topics less directly related to nutrition). This funding supported almost 4,900 projects across at least 24 of NIH’s 27 institutes, centers, and offices. If that sounds impressive, it amounts to just 5% of NIH’s total funding. Just 1% of all projects supported by NIH in recent years have focused on the role of diet in the prevention or treatment of disease in humans — the rest focused on basic science and preclinical research.
Compare this to the diet-associated cost of cardiometabolic disease in the U.S., which was recently estimated to be $50.4 billion per year. This outstrips the NIH’s annual budget for 2021 and the combined annual appropriations for the Centers for Disease Control and Prevention, the Environmental Protection Agency, and the Food and Drug Administration.
Over the years, the NIH has made sporadic attempts to coordinate the diverse nutrition research under its wing. In 1975, it established the NIH Nutrition Coordinating Committee in the Office of the Director, the highest level of leadership at NIH. But that committee was summarily shifted to the National Institute of Diabetes and Digestive and Kidney Diseases in 1993, and then relegated still lower within NIDDK in 2015, when it was renamed the Office of Nutrition Research.
In 2020, as Congress was considering whether to create a wholly new institute, the National Institute of Nutrition, the NIH released its first agency-wide Strategic Plan for NIH Nutrition Research with a focus on precision nutrition. No new nutrition-focused institute has been created, though the Office of Nutrition Research was moved back to the Office of the Director in 2021.
The strategic plan and office reshuffling are unlikely to be sufficient actions in the effort to curb rising rates of diet-related diseases. Establishing a National Institute of Nutrition could bolster essential nutrition research and provide the coordination necessary to address increasingly complex and interdisciplinary issues. This institute would be integral to achieving the goals of NIH’s strategic plan and developing a research blueprint for addressing chronic disease using a combination of basic science, clinical trials, epidemiology, and policy research.
Research coordinated by the National Institute of Nutrition could range from foundational, such as identifying new biomarkers of nutrition status, to cross-cutting, such as understanding links between nutrition, health, and the food system. It could leverage the agency’s current research on cancer, aging, obesity, diabetes, cardiovascular disease, and health disparities to drive research aimed at better understanding individual, social, and environmental determinants of nutrition and health and developing translational solutions.
But coordination beyond the world of research is also necessary. A recent Government Accountability Office report identified 200 diet-related efforts — including research, education, clinical services, food assistance, and regulation — scattered across 21 federal agencies. The report recommended that Congress direct a federal body to develop and carry out a strategy for such efforts with the goal of reducing chronic disease risk. Creating a White House Deputy Assistant to the President for Food and Nutrition Policy could harmonize these activities by leading a cross-agency federal food and nutrition working group. This group could coordinate between agencies and report to the President, the Cabinet, and Congress on issues ranging from nutrition, food access, and health equity to sustainability and climate change.
The cross-government cooperation required to address the ongoing infant formula crisis and the effects of climate change on and by the food system only highlight the need for such a body. The administration has, in effect, already created this working group in preparation for the White House conference as the need to organize topics of discussion and policy priorities across numerous federal agencies has arisen.
Coordination and investment in nutrition research at the federal level can take many forms. A new institute at NIH and a White House Deputy Assistant to the President are only the beginning of the solution. But their establishment, which should be a focus of the upcoming White House Conference, would be a positive step towards efficiently utilizing limited nutrition science dollars to combat the effects of diet-related disease.
Stephanie Rogus is a registered dietitian who leads the scientific integrity initiative for the Center for Science in the Public Interest (CSPI). Peter G. Lurie is a physician, the president and executive director of CSPI, and a former associate commissioner of the Food and Drug Administration.
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