Introduction
The US faces remarkable food and nutrition challenges. More Americans are sick than are healthy, with diet-related illnesses playing a major role including obesity, type 2 diabetes, cardiovascular diseases, cancers, food allergies, and more (1). The incidence and prevalence of many of these conditions have increased dramatically in recent decades. In addition to burdens on health and productivity, these diet-related diseases are creating tremendous strains on health care spending, health disparities, government budgets, economic competitiveness of American businesses, and military readiness. Innovations in food and nutrition should improve human health while also preserving our natural resources, a crucial new area of intersecting science and policy.
Many of these strains in food and nutrition have been further exposed and exacerbated by COVID-19 (2). This includes, for example, challenges related to hunger and food insecurity; major diet-related comorbidities for hospitalization and death from COVID-19 such as diabetes, obesity, and hypertension; insufficient evidence on optimal population resilience through better nutrition; and the need to further improve the surveillance on and coordination of food production and supply chains (3–9).
While advancing nutrition research has provided evidence to describe the general contours of healthy eating patterns, it has also highlighted many critical new, unanswered questions on food and nutrition and the national challenges we face (10). Important nutrition research is currently being supported by >10 federal departments and agencies (11). Yet, as diet-related conditions and their societal burdens have climbed in recent decades, funding for such research has remained flat (12). In addition, no concrete action has emerged to successfully harmonize and leverage nutrition research across the government, despite consistent recommendations over at least 5 decades for a robust coordinating federal entity (13). A major, new federal effort to strengthen and coordinate nutrition research could rapidly generate the necessary evidence base to address multiple national challenges, providing major benefits and ROI.
The aim of this white paper is to evaluate key issues relevant to such a scientific effort, including the following:
The mounting diet-related health burdens facing our nation and the corresponding economic, health equity, national security, and sustainability implications;
The current federal nutrition research landscape and existing mechanisms for its coordination among the diverse departments and agencies working to address these challenges;
The opportunities for and potential impact of new fundamental, clinical, public health, food and agricultural, and translational scientific discoveries related to nutrition; and
The best strategies to further strengthen and coordinate federal nutrition research, including relevant advantages, disadvantages, and potential executive and legislative considerations for a path forward.
This white paper is intended to invite comment and discussion from all stakeholders who care about strengthening nutrition research, whether to improve health, lower public and private health care spending, reduce disparities, promote business innovation, reinvigorate rural communities, preserve our national resources, or strengthen national security. Key audiences for this white paper include the following:
Elected and appointed federal officials in both executive and legislative branches;
Federal science agency leaders and program and policy staff;
Federal military leadership;
The academic community;
Clinical and scientific professional organizations;
Nonprofit advocacy groups;
Allied health professional organizations;
US businesses whose efforts, employees, and competitiveness can be benefited by federally supported nutrition discoveries;
The media, who communicate key nutrition-related messages; and
The public who rely on and desperately need advances in federally supported nutrition research to help improve and sustain their health and communities.
This white paper was informed by extensive background research and stakeholder conversations. This research included a review of government and other published documents on federal nutrition research; discussions with expert groups, advocacy organizations, and scientific societies; and in-person or phone meetings with >50 federal staff in executive and legislative roles, as well as with a variety of extramural researchers in academic and nongovernmental organizations. The writing group reached out to all 10 departments and agencies participating in the ICHNR, particularly for assistance in estimating their relevant budget for nutrition research. The legislative history for the NIH was independently collected by 2 team members with high agreement. Legal experts at the Center for Health Law and Policy Innovation at Harvard Law School reviewed this white paper with special attention to the section on Options and the corresponding legislative and executive considerations. We also reviewed feedback received through the American Society for Nutrition (ASN) request for member input regarding the concept of a National Institute of Nutrition and through a related panel session and Q&A at the ASN Nutrition 2019 annual scientific conference. We also sought input from members of the Nutrition Action Alliance (NAA), a coalition of organizations working to advance federal nutrition research, nutrition education, and nutrition monitoring and surveillance, among other activities, and which includes ASN, Academy of Nutrition and Dietetics, American Society for Parenteral and Enteral Nutrition, Association of Nutrition Departments and Programs, Institute of Food Technologists, National Board of Physician Nutrition Specialists, Society for Nutrition Education and Behavior, and The Obesity Society. The writing group used these document reviews, one-on-one conversations, stakeholder interviews, and additional discussions to maximize candid, confidential reflections following Chatham House Rules on the past and present state of federal nutrition research, the challenges and opportunities, and the best available strategies for moving forward.
We hope this white paper provides an objective, informative summary of the 1) burdens, 2) current federal nutrition research landscape, 3) opportunities, and 4) options for strengthening national nutrition research. Ultimately, we hope it helps lay the foundation for accelerated advances in nutrition research to help improve and sustain the health of all children, adults, families, and communities.