Executive Summary

Aims
This white paper aims to evaluate key issues relevant to federal nutrition research, including the following:
The mounting diet-related health burdens and corresponding economic, health equity, national security, and sustainability implications;
The current diverse federal nutrition research landscape and existing mechanisms for its coordination;
The opportunities for new nutrition-related discoveries in fundamental, clinical, public health, food and agricultural, and translational scientific research; and
The best strategies to further strengthen and coordinate federal nutrition research, including advantages, disadvantages, and potential paths forward.
This effort, informed by extensive background research and interviews, is intended to invite comment and discussion from all key stakeholders and help lay the foundation for accelerated scientific advances in nutrition to improve and sustain the health of all Americans.

The burden
Diet-related illnesses are the leading source of poor health in the US. Nearly 3 in 4 American adults are overweight or obese, and 1 in 2 have diabetes or prediabetes—and these rates continue to rise. Poor nutrition further contributes to cardiovascular diseases, several cancers, poor gut health, and many other disorders. Beyond effects on health, these diet-related diseases create enormous strains on productivity, health care spending, health disparities, and military readiness (Figure 1). Our food system also strains our natural resources, a crucial new area of intersecting science and policy.
FIGURE 1  Examples of identified diet-related burdens that could be addressed by more coordinated and strengthened federal nutrition research. COVID-19, coronavirus disease 2019. Graphic design support courtesy of Ink&Pixel Agency. Profound disparities in both diet-related chronic diseases and food insecurity, for example, are experienced by low-income, rural, minority, and other underserved populations. Nearly 3 in 4 young Americans do not qualify for military service, with obesity being the leading medical disqualifier. Obesity and other diet-related chronic diseases are endemic among veterans, while obesity and food insecurity coexist in many active-duty military families. Over just 50 y, federal health care spending has risen from 5% to 28% of the federal budget, while US business (inflation-adjusted) spending on health care has increased from $79 billion to $1180 billion. Approximately 85% of current health care spending is related to management of diet-related chronic diseases. Estimated US government expenditures on direct medical care for diabetes alone (∼$160 billion/y) exceeds the annual budgets of many individual federal departments and agencies, including, among others, the Departments of Education (DoE), Homeland Security (DHS), and Justice (DoJ) and the NIH, CDC, Environmental Protection Agency (EPA), and FDA.
These strains have been further exposed and exacerbated by coronavirus disease 2019 (COVID-19). This includes, for example, challenges related to hunger and food insecurity, major diet-related comorbidities for poor outcomes from COVID-19, insufficient evidence on optimal population resilience through better nutrition, and inadequate surveillance and coordination of our food system.
Addressing each of these issues requires a better understanding of their multilevel, interrelated biological, individual, social, and environmental determinants, and the corresponding translational solutions. However, the current scope and pace of nutritional knowledge and discovery are insufficient to address the fundamental nutrition-related challenges facing the nation.

The current landscape
More than 10 federal departments and agencies currently invest in critical nutrition research. Their relative investments in nutrition research have remained flat or declined over several decades—even as diet-related conditions and their societal burdens have climbed. The NIH is the largest funder, with nutrition research investments estimated at $1.9 billion annually (∼5% of total NIH funding) for fiscal year 2019. Approximately 25% of this funding (1.3% of total NIH funding) focuses on diet for the prevention or treatment of disease in humans. This NIH nutrition research is conducted and supported across nearly all of the 27 current NIH institutes and centers. Coordination of these efforts has been challenged by successively smaller NIH coordinating offices with decreasing stature, staff, and resources. The USDA is the second-largest funder of US nutrition research, with an estimated annual budget of ∼$0.17 billion for fiscal year 2019 across several institutes and services. The USDA works to provide Americans with safe, nutritious, and wholesome food and works to ensure the foods and beverages our nation produces optimally benefits human and animal health and to address food insecurity through the administration of 15 federal nutrition assistance programs. Several structures work to improve research coordination within the USDA, although a recent USDA workshop and Government Accountability Office (GAO) report identified gaps and opportunities in nutrition research coordination. Multiple other federal departments and agencies invest in nutrition research, including the CDC, FDA, Department of Defense (DoD), US Agency for International Development (USAID), Department of Veterans Affairs (VA), National Aeronautics and Space Administration (NASA), and others.
Consistent with this fragmented infrastructure, multiple major reports over 50 y have called for greater coordination of federal nutrition research. Current coordination efforts include the Interagency Committee on Human Nutrition Research (ICHNR), which currently meets about twice a year to work on the following activities, among others: food and nutrition monitoring and surveillance, the joint USDA–Department of Health and Human Services (-HHS) activity to produce the Dietary Guidelines for Americans (DGAs) and certain regulatory, communication, and educational activities. However, no concrete authority has been created to successfully harmonize and leverage the federal investments in nutrition research.
Overall, this white paper and several prior reports found these efforts to be important but insufficient to address current and rising diet-related disease burdens, food insecurity, health disparities, health care costs, challenges to military readiness, and intersections with food and agricultural production, supply chains, and sustainability.

The opportunity
Several specific priority areas in nutrition research have been identified by various federal and nongovernmental organizations. However, most have not been adequately addressed. Greater federal coordination and investment in nutrition research could accelerate discoveries across these critical areas (Figure 2).
FIGURE 2  Opportunities for enhanced federal nutrition research coordination and investment. DGAs, Dietary Guidelines for Americans; DoD, Department of Defense; NASA, National Aeronautics and Space Administration; SNAP-Ed, USDA Supplemental Nutrition Assistance Program Education; USAID, US Agency for International Development; VA, Department of Veterans Affairs. Graphic design support courtesy of Ink&Pixel Agency. Several lines of evidence support a strong return on investment (ROI) for an expanded and coordinated nutrition research effort. As stated by the FDA Commissioner in 2018 at the National Food Policy Conference, “Improvements in diet and nutrition offer us one of our greatest opportunities to have a profound and generational impact on human health .… The public health gains of such efforts would almost certainly dwarf any single medical innovation or intervention we could discover.”

The options
Any new federal nutrition research investment and coordination structure must leverage, harmonize, and catalyze the existing efforts being led across multiple federal departments and agencies. Two major complementary strategies were identified: 1) a new authority for robust cross-governmental coordination of nutrition research and other nutrition-related policy and 2) strengthened authority, investment, and coordination for nutrition research within the NIH.
Specific promising options to advance these 2 strategies were identified (Box 1); and for each option, potential advantages and disadvantages, executive and legislative considerations, and paths forward are discussed. Improved coordination between federal departments and agencies conducting nutrition research was identified as having tremendous potential for accelerating essential basic, clinical, public health, and translational discoveries. Increased authority, coordination, and funding for nutrition science within NIH was also identified as being essential for accelerating needed discoveries. Appropriate efforts should leverage and amplify, not replace, compete with, or isolate existing nutrition research efforts across NIH, USDA, or other departments and agencies. The cross-government strategy and within-NIH strategy were identified as complementary, with benefits accruing independently and further synergies to be gained by joint implementation.
Box 1  Promising cross-governmental and NIH options to strengthen and accelerate national nutrition research1
Cross-governmental A new Office of the National Director of Food and Nutrition (ONDFN)
A new US Global Nutrition Research Program (USGNRP)
A new Associate Director for Nutrition Science in the White House Office of Science and Technology Policy (OSTP)
A new US Task Force on Federal Nutrition Research
Within NIH A new National Institute of Nutrition (NIN)
A new National Center for Nutrition Research (NCNR)
A return of the Office of Nutrition Research (ONR) into the NIH Office of the Director
Development of new trans-NIH initiatives in nutrition research
Within USDA Increased investment in nutrition research across the USDA Research, Education, and Economics mission area
Expanded USDA research to improve public guidance and education
Innovative USDA research to strengthen benefits of nutrition assistance programs
1  Additional relevant priorities to strengthen federal nutrition research within other departments and agencies, such as DoD, USAID, and FDA, were recognized and should be the subject of future reports.  Further complementary actions to accelerate federal nutrition research were identified at USDA. First, to increase investment in nutrition research for the Agricultural Research Service (ARS) including its network of Human Nutrition Research Centers, the National Institute of Food and Agriculture (NIFA) extramural research programs, and the Economic Research Service (ERS) programs, which assesses demographic, social, informational, and economic determinants of dietary consumption and associated health outcomes. Second, to expand USDA research that evaluates and improves major ongoing efforts for public guidance and education on nutrition. And third, to build the robust evidence base and collaborations needed to strengthen the positive impacts of the ∼$100 billion/y federal investments in nutrition assistance programs.

Conclusions
This white paper identified many stark and growing national challenges related to nutrition. Our research further documented a diversity of federal investments in nutrition research across departments and agencies, but with flat or declining funding and with suboptimal coordination authority. The opportunities to be gained by greater coordination and investment in federal nutrition research are clear, with potential for large and rapid ROI. This white paper identified and described 2 priority strategies, including 1) a new authority for cross-governmental coordination and 2) strengthened authority, investment, and coordination within NIH. Additional important strategies were also identified at USDA. All these strategies were found to be complementary, providing independent as well as synergistic benefits. The identified specific options would help create the new leadership, strategic planning, coordination, and investment the nation requires to address the multiple nutrition-related challenges before us, and grasp the corresponding opportunities.