Should Robert F. Kennedy Jr. be confirmed as secretary of Health and Human Services, it will bring real political power to the network of wellness influencers who populate the Make America Health Again movement.
Physicians like me are alarmed about many of Kennedy’s views on health. His anti-vaccination positions and his calls to prosecute medical journals, among other dangerous views, should never be normalized, are disqualifying for the position he seeks, and threaten to beat back decades of progress in public health. In the face of this, some have found solace in his and MAHA’s passion for addressing chronic diseases. But as a cardiologist in training who regularly sees patients grappling with chronic metabolic diseases like high blood pressure, diabetes, and obesity, I remain skeptical. In the MAHA universe, these diseases are self-inflicted wounds, caused by poor diet choices or a lack of discipline. Solutions, to them, often involve telling people to put down the junk food, avoid modern medicine, or purchase an expensive product or service, with a dash of conspiracy-mongering.
But the reality I see in my clinic is quite different. Sure, ultra-processed foods undoubtedly play a role in perpetuating metabolic disease. I am all for making healthier foods more available, and importantly more affordable.
But chronic diseases, particularly obesity and the metabolic diseases cascading from it, are rooted in other far-reaching social and environmental issues, often beyond the control of an individual. Bone broth, nutraceuticals, and raw milk will not address America’s epidemic of metabolic diseases.
If Kennedy and his team, if ultimately confirmed, are serious about tackling chronic disease, particularly obesity, they would do well to spurn the advice of out-of-touch influencers. He’d first and foremost support expanding access to GLP-1 agonist therapies, which have been shown to have significant benefits to treating metabolic disease, to those eligible and interested in taking them after a discussion with their doctor. (A big part of expanding access would mean making them affordable.) That would mean walking back his previous statements. “They’re counting on selling [GLP-1s] to Americans because we’re so stupid and so addicted to drugs,” he said on Fox News.
Instead, he should look to what his uncle may have done: support a large-scale public health program promoting evidence-based solutions, implemented locally and meeting people where they are. We could call it a Marshall Plan for obesity.
For inspiration, one successful program he and his team could look to is the Metropolitan Area Project Plans (MAPS) 3 initiative in Oklahoma City, the capital of my home state. Implemented more than a decade ago, MAPS 3 was an ambitious, voter-approved infrastructure project motivated, in part, by a rising rate of obesity in the city noted by its Republican mayor, Mick Cornett. Taking a systematic and holistic approach to obesity, the program used a sales tax to fund building a public park downtown, a new streetcar transit system, and multiple community wellness centers, as well as sidewalks and bike paths throughout the city. The project was supervised by a volunteer citizens oversight committee, and paired with a public health initiative, announced by the mayor in front of the city zoo’s elephant exhibit no less (to express the gravity of the situation), motivating citizens to lose more than 1 million pounds collectively. In subsequent years, the city’s obesity rates stalled while the national rate grew.
The program, to be clear, has its faults, and solutions for each community will invariably look different. But a similar, locally focused approach, uniting disparate programs already addressing obesity at the federal level, could be scaled nationally in a Marshall Plan for obesity. The original plan lifted Western Europe out of the aftermath of World War II primarily by offering direct grants. Similarly, with a Marshall Plan for obesity, funding, primarily from federal appropriations, could be distributed as grants to communities and spent by local governments toward health projects, which can design programs that are equitable, inclusive, and engaging people on the ground and the private sector. This could be further supplemented by consumption taxes on items like tobacco, alcohol, and sugar-sweetened drinks.
A program like this would be expensive. But so is the cost of obesity in the United States today, estimated to incur over $170 billion in medical-related costs alone annually. Supported by a growing body of literature linking metabolic diseases to social and environmental determinants of health, such funding could be spent toward building affordable housing, creating green spaces and eliminating fitness deserts, creating more walkable and pedestrian-friendly communities through upgrading our public transportation systems, distributing blood pressure cuffs, promoting health and nutrition literacy, fighting disinformation on medications like statins, or offering credit at farmers markets. This program, alongside expanding access to GLP-1 agonists, could be complementary to efforts to reform our food system. It could also offer an opportunity to learn from one another, and to test what does and does not work.
Of course, I say much of this wishfully. Kennedy has built his career railing against tenets of modern medicine and public health, and although I (and we) can hope, he is not likely to change his tune now. But stranger things have happened. The political status quo has been upended, and people’s views on issues can evolve when in positions of power. If Kennedy’s passion for this subject is genuine, he would look away from TikTok and Instagram posts promoting supplements, and look toward implementing evidence-based solutions that meet people where they are. Whether or not he and his team adopt these strategies, or others like it, the health of millions of Americans is simply too important to be sacrificed to fringe ideas and political posturing.
Vishal Khetpal is a fellow in cardiovascular disease in the Brown University Cardiology Fellowship Program. The views expressed are those of the author and do not necessarily reflect the views of his employers.