Gerald Cox, MD – Engineered to Crave: How Big Food Hijacked the American Plate

Dr. Gerald Cox joins Dr. Palmer for a revealing conversation about a shift most clinicians were never trained to see—how the food on our shelves stopped being food and became a product, deliberately designed to be difficult to stop eating. As a preventive medicine specialist focused on reversing cardiometabolic disease, with roots in obesity, lifestyle, and internal medicine, Dr. Cox brings both the science and a personal story: his own adolescence as an overweight kid who thought he was simply making bad choices, before realizing the choices themselves had been engineered.

Dr. Cox walks through the machinery hiding behind familiar labels. He explains how “flavor engineering” blends taste, aroma, color, and texture to defeat moderation, and why a “healthy” protein bar can carry a paragraph of unfamiliar ingredients. He traces how tobacco companies—under public-health pressure in the 1980s—bought their way into the food supply, bringing Oreos, Kool-Aid, Lunchables, and their marketing playbooks with them. And he connects high-fat, high-salt, low-fiber formulations to the brain’s dopamine and reward pathways, explaining why “bet you can’t have just one” was never a joke.

The episode also takes on the harder questions underneath the trend lines. When food behavior is shaped by biochemistry and industry design, how should clinicians respond—with blame, or with grace and tools like the Yale Food Addiction Scale? What does the latest research from the Lancet and the American Journal of Public Health reveal about engineering techniques and their public-health cost? And with “Make America Healthy Again” messaging, the FDA’s “natural” loophole, and food dyes all moving into the political mainstream, could this be a once-in-a-generation opening for real reform?

Throughout, one truth anchors the discussion: this isn’t a story about willpower—it’s about environment. Understanding how the modern food supply was built is the first step toward meeting patients with compassion, and toward giving them back some control over what ends up on their plate.

Here are 5 takeaways from our conversation with Dr. Cox:

1. Ultra-processed foods are engineered to be irresistible

The episode explains that many modern foods are intentionally designed to maximize craving and repeat consumption. Through flavor engineering, bright packaging, and carefully chosen ingredient combinations, these products are built to be highly palatable and difficult to stop eating once started.

2. Food choices are shaped by biology, psychology, and environment

The hosts stress that eating behavior is not just about personal discipline. Childhood experiences, advertising, convenience, and repeated exposure all influence what people reach for, while brain reward pathways can make certain foods feel almost automatic to choose.

3. The food industry borrowed tactics from tobacco

A major theme is that tobacco companies brought their business model into the food world. The episode points to corporate acquisitions, product optimization, and marketing strategies that were used to scale highly processed foods in the same way tobacco companies once scaled cigarettes.

4. Ultra-processed foods may activate addiction-like pathways

The conversation highlights how foods high in calories, fat, sugar, and salt can stimulate reward circuitry in the brain. When those foods are also low in fiber and highly engineered for taste and texture, they may create patterns that resemble addictive behavior rather than simple preference.

5. This is becoming a public health and policy issue

The episode frames ultra-processed foods as a systems problem, not just an individual one. The hosts discuss the need for clearer labeling, updated terminology, stronger oversight, and policy changes that help consumers make better choices while pushing companies toward greater transparency.

Transcript:

Dr. Gerald Cox:
People aren’t really comfortable going down that aisle with the chips and being blinded by all the yellow, red, and blue packaging. It’s almost dizzying when you think about it. We all know what’s in that aisle—the sodas, the chips, and sometimes the cereals that we know aren’t really great for us.

Dr. Ned Palmer:
Hello, everyone, and welcome back to The Podcast for Doctors (By Doctors). My name is Dr. Ned Palmer, and today I’m joined by Dr. Gerald Cox, who I’ll introduce in just a moment.

We’re excited to have him back to talk about nutrition, why food is life and health, and how clinicians can take actionable steps in response to the rise of processed and ultra-processed foods. This is an incredibly important topic because we see the downstream effects every day. Diseases like obesity, metabolic syndrome, and diabetes can all be linked, quite compellingly, to nutrition.

Nutrition science was one of the weakest parts of my medical education. I think we joked about this last time. I had to memorize how many kilocalories were in each gram of fat, and I was tested on it, but to this day, I have no idea how to connect that information to walking down a grocery store aisle. I’m excited to bridge that gap today with our subject matter expert, Dr. Gerald Cox.

Today we’re joined by Dr. Gerald Cox, a physician, educator, and entrepreneur dedicated to preventing and reversing cardiometabolic disease. As a specialist in preventive medicine, obesity medicine, lifestyle medicine, internal medicine, and artificial intelligence, Dr. Cox has built his career around a simple but powerful question: How do we help people live longer, healthier lives?

He serves as an Associate Professor at Loma Linda University—located in one of the world’s Blue Zones, known for having some of the longest-living populations on the planet—and is the co-founder of Mirror Health and Wellness. His work focuses on improving patient outcomes, advancing population health, and building better systems of care to address some of healthcare’s biggest challenges.

Dr. Cox, welcome back to The Podcast for Doctors (By Doctors).

GC:
Dr. Palmer, it’s always a pleasure spending time with you and discussing these topics. I appreciate the opportunity to help enlighten people about what they’re facing in their everyday lives.

NP:
As always, we want to keep this clinically focused. One of the challenges for many of us who went through years of medical training is that nutrition was rarely connected to clinical practice. Most of my exposure was asking a dietitian to help with TPN or tube feed orders, and that was about the extent of it.

That’s such a narrow view of food as medicine. Today, I’m excited to widen that lens and discuss what practical information we can give our fellow clinicians every day about making healthier food choices and the clinical outcomes we can expect.

GC:
I completely agree. You had me the moment you mentioned the nine kilocalories per gram of fat. I remember that USMLE question and thinking, “What was the point of that?”

Honestly, if I hadn’t been obese as a child and later become a personal trainer while trying different weight-loss programs myself, I probably would have relied solely on what I learned in medical school. Instead, I found that my personal experiences helped me care for patients far more than sitting through lectures ever did.

Fortunately, things seem to be changing, but it’s remarkable that nutrition wasn’t a larger focus in our medical training.

NP:
Absolutely. I’d love to revisit your story because it’s central to why you’re so passionate about obesity medicine. It’s also worth pointing out that you accomplished your own weight loss before medications like Ozempic were available. You put in the work, and I respect that. I understand why this topic resonates so deeply with you.

GC:
Those were hard-earned calories.

NP:
Absolutely. Diet and lifestyle are probably the two hardest things for people to change, yet we tell patients they need to change them all the time without giving them much grace in the process.

GC:
Exactly. Too often, we simply pass the buck and send a referral. Fortunately, you have a lot of great connections, including a dietitian.

NP:
Absolutely. I’d love to hear more about your personal connection to this work and how your training in obesity medicine expanded into lifestyle medicine, nutrition, and food science. Those are distinct fields, and you’ve managed to bring them together.

GC:
A lot of it goes back to my childhood. I struggled with obesity as an adolescent and tried several weight-loss programs. Looking back, I realize my diet included many things I didn’t understand at the time. We’re all shaped by our environments, and mine encouraged weight gain.

I was teased for being overweight. Kids can be brutally honest, and that became an eye-opening experience. Going through those weight-loss programs taught me that I could make choices to improve my health.

But as I continued training in obesity, lifestyle, and preventive medicine, I realized it wasn’t as simple as personal choice. The medical literature increasingly showed that what we thought were choices were often heavily influenced by factors that resembled addiction or sophisticated marketing.

Think about putting a wrapped Christmas present in front of a child. The child may believe opening it is a choice, but there are many psychological forces driving that decision.

NP:
Exactly. Addiction medicine went through a similar evolution. For years, we blamed patients and viewed addiction as a moral failing. Now we understand there’s chemistry, biology, psychology, and, in this case, even corporate incentives designed to influence behavior.

One thing I really appreciate is how you explain the history behind all of this. One of my favorite things you’ve said is, “We the people have lost control of our food supply.” I’d love for you to walk us through how we got here.

GC:
We’re approaching the 250th anniversary of the United States, and the phrase “We the people” really resonates.

The reality is that we’ve lost control of our food supply. We’re no longer eating foods made from a handful of simple ingredients.

I remember my significant other coming home from Trader Joe’s with what she thought were healthy protein bars. She offered me one, and the first thing I did was read the ingredient list.

I was hoping to see something simple—peanuts, rolled oats, maybe a natural binder—but instead there was an entire list of ingredients: riboflavin, enriched flour, emulsifiers, and many others.

Even when shopping somewhere known for healthier options, you still have to read labels carefully because we’ve moved far beyond minimally processed foods. That makes making healthy choices much more difficult.

NP:
Absolutely. We’re going to spend a lot of time talking about what’s actually in our food because that’s really the foundation of today’s discussion on ultra-processed foods.

There’s the food science behind all those ingredients, but there’s also the psychology behind how foods are marketed. It reminds me of the old slogan, “Bet you can’t eat just one.”

Can you explain how advertising psychology and food science work together to influence our decisions?

GC:
Absolutely.

One term that’s becoming much more common in the medical literature is flavor engineering. It really caught my attention after the American Journal of Public Health published a large collection of research on ultra-processed foods, which has since been covered by outlets like NPR, CNN, and the BBC.

When I first heard the term “flavor engineering,” I thought, “I understand food science, but engineering?”

As I looked deeper, I realized it combines multiple disciplines. It’s the science of designing taste, aroma, appearance, and even perception to influence how we experience food, beverages, and even pharmaceuticals.

That reminded me of my experience reading ingredient labels at Trader Joe’s. I wanted something simple, but instead I found long lists of unfamiliar ingredients. The deeper I looked, the more I realized that many of these products are carefully designed to influence our decisions in ways we don’t consciously recognize.

A good example is NyQuil.

When we walk down the pharmacy aisle, we recognize the purple bottle for nighttime relief and the orange bottle for daytime relief. We associate those colors with how we expect the product to work.

But those colors don’t naturally occur. They’re created with dyes like Red 40 and Blue 1 to reinforce those perceptions.

At the same time, research has raised concerns about certain artificial dyes and their possible associations with behavioral effects such as hyperactivity, attention difficulties, and ADHD-related symptoms, particularly in children. Parents may think they’re simply giving their child cold medicine, without realizing there are additional ingredients that have become subjects of ongoing public health research.

Then I looked at one of my own weaknesses: truffle oil.

Those truffle fries smell amazing. You catch that aroma and immediately want them because truffles are known as an expensive culinary ingredient.

But many truffle oils don’t actually contain truffles. Instead, manufacturers identify the compounds responsible for the aroma and recreate them.

One example is a compound called 2,4-dithiapentane, which can be produced from petroleum, plants, animal sources, or microbial fermentation. Extracting it from real truffles is extremely expensive, so manufacturers often obtain it from other sources and add it to a neutral oil.

As a result, consumers believe they’re buying a premium truffle product, when in reality they’re purchasing an oil that’s been engineered to mimic the flavor and aroma of truffles.

Those are the kinds of loopholes that flavor engineering allows, enabling companies to produce inexpensive products while marketing them as premium experiences.

NP:

I love the term flavor engineering because we’ve all seen—and experienced over the past few decades—the rise of imitation foods.

For me, it wasn’t truffle oil. We’ve talked about your love of truffles. Mine was vanilla. Vanilla extract has become a highly engineered product where the flavor compound is isolated, reproduced—sometimes using petroleum-derived processes—and then combined with alcohol and brown food coloring. The result is very different from naturally occurring vanilla, which typically comes from places like Madagascar or the Caribbean.

In some ways, flavor engineering has expanded access to products that were once considered luxury items. But those aren’t essential foods. The concern is that this same engineering has now worked its way into the foods that make up our everyday diets.

A big part of that story is the growth of the food industry, particularly in the United States, and how it became increasingly corporatized. That really takes us back to the 1980s.

I’d love for you to talk about what I think are two of the central players in this story: the tobacco industry and the processed food industry. Specifically, how did major tobacco companies begin moving into processed foods as a new source of revenue?

GC:

When we were preparing for this conversation and reviewing the research behind these recent publications, it was fascinating to see how this all began.

In the 1980s, tobacco companies were facing increasing public scrutiny. The link between smoking and lung cancer had become undeniable, addiction was receiving greater attention, and new legislation was beginning to emerge. Tobacco companies were under significant pressure.

They responded by diversifying their portfolios.

The question became: How do we apply everything we’ve learned—and invested in—to another industry?

One example is Philip Morris, the company behind Marlboro cigarettes and ZYN nicotine pouches. They acquired General Foods.

NP:

I have to interrupt for a second, Dr. Cox.

You’re so healthy that you pronounced it “Z-Y-N.” It’s actually pronounced “Zin.” That’s what all the kids call it.

I just have to point out how far removed you are from that world. You looked at the capital letters and thought it must be an acronym. I love that.

GC:

I may not know how to pronounce ZYN, but I definitely know Jell-O, Kool-Aid, and Tang.

What surprised me was learning that General Foods—the company behind those household brands—was acquired by Philip Morris.

As a kid growing up in the 1990s, I loved Tang and Kool-Aid. They had incredible marketing campaigns. I had no idea those products were part of a tobacco company’s diversification strategy.

Looking back, it’s almost funny to realize Philip Morris entered my living room disguised as the Kool-Aid Man. I certainly didn’t recognize that at the time.

It’s remarkable when you dig into the history.

NP:

I don’t think anyone would have welcomed the Marlboro Man the way we welcomed the Kool-Aid Man.

You’re absolutely right—most people don’t know this history.

When you think about it, the transition isn’t that surprising. Tobacco companies had already mastered the process of taking a natural product, engineering it for mass production, and distributing it at enormous scale.

The same playbook was applied to food over the next 40 years. Natural, food-based products became increasingly engineered to improve manufacturing, distribution, shelf life, and consumer appeal.

To this day, I couldn’t tell you everything that’s in Tang or Kool-Aid, but those products became incredibly easy to manufacture and distribute. Companies like Philip Morris—and later R.J. Reynolds—were simply applying a strategy they had already perfected.

GC:

Exactly.

R.J. Reynolds, the company behind brands like Camel, Newport, and American Spirit, made a similar move by acquiring Nabisco.

It’s hard for most people to eat just one Oreo—or even one Ritz cracker. Then there were brands like Cadbury. Learning that these iconic food brands became part of tobacco company portfolios was eye-opening.

Think about Oscar Mayer, Capri Sun, and Lunchables.

I loved making those little Lunchables pizzas as a kid. What I didn’t realize was that those products were the result of years of consumer research, including studies designed to understand children’s preferences.

One of the most fascinating things I found in the literature involved the engineering behind the food itself.

Researchers describe how certain flavor compounds were encapsulated within lipid and protein structures that delayed the release of flavor. In other words, the food was engineered so flavors were released over time rather than all at once.

That delayed release helped stimulate dopamine and serotonin pathways in ways that made the food more rewarding. From a neurological perspective, our brains were being influenced by very sophisticated food engineering.

It really brings us back to that old advertising slogan: “Bet you can’t eat just one.”

NP:

Exactly. Their multi-billion-dollar bet was that you wouldn’t stop at one because they were intentionally pulling those levers.

GC:

Like the Wizard of Oz behind the curtain.

NP:

Exactly. As they controlled the ingredients and engineered the experience.

GC:

Right—and all those bright colors.

NP:

All those bright colors and everything else that goes into it.

I’d also like to talk about how these companies continued consolidating. Most people today probably recognize Nabisco as being associated with Kraft, so there was a lot of acquisition and consolidation happening across the industry.

GC:

Exactly.

After acquiring General Foods, Philip Morris became so successful that it eventually acquired Kraft Foods as well.

That means products like Lunchables, DiGiorno pizza, Oscar Mayer hot dogs, and Capri Sun all became part of the broader story of the tobacco industry’s expansion into food.

As those companies merged, the industry continued consolidating, creating significant corporate power.

It actually reminds me of the book—and later the movie—Barbarians at the Gate.

Have you ever come across it?

NP:

No, I haven’t.

GC:

It’s fascinating. Once you start reading this research, you end up going down all kinds of rabbit holes.

One example is Barbarians at the Gate. The story centers around a major corporate takeover battle over RJR Nabisco. There was an aggressive bidding war as investors tried to gain control of what had become an incredibly profitable industry. It ultimately led to leadership changes, congressional attention, and became one of the defining corporate stories of the late 1980s.

As you and I discussed earlier, it’s remarkable to see how business strategy, corporate finance, and the pursuit of new markets all intersected with consumer behavior. Companies weren’t simply selling food—they were investing in products that generated enormous revenue while encouraging purchasing behaviors that weren’t necessarily aligned with long-term health.

NP:

That brings us to how these food companies evolved and how flavor engineering became such a central part of the industry. Food became increasingly scientific, with much of the focus placed on consumer appeal, repeat purchases, and production costs, while comparatively less attention was given to long-term health outcomes.

The American Journal of Public Health recently published a landmark collection of studies on ultra-processed foods, and we’re going to dive into those shortly.

Before we do, though, I’d like to talk about addiction.

As you’ve already mentioned, there’s a significant overlap between food science and addiction science. You’ve talked about dopamine pathways, which are the same neurological pathways involved in many forms of addiction. Most people think about eating disorders like anorexia, bulimia, or binge eating, but they don’t often think about the addictive potential of certain foods.

From your perspective as a specialist in obesity and lifestyle medicine, what role can food play in activating those addiction pathways?

GC:

It’s a really interesting area of research.

One study used artificial intelligence to examine how different combinations of macronutrients affect the brain’s reward pathways. I appreciated the study because it was well designed and relatively reproducible.

The researchers found that foods with high calorie density were much more likely to activate reward pathways.

Take foods like beans, carrots, celery, and other vegetables you might find in a traditional vegetable chili. Those foods contain a lot of water, are relatively low in calorie density, and tend to be more protective.

Now compare that with foods that are dry, calorie-dense, and high in fat.

The research showed that combining high calorie density with saturated fat—particularly palmitic acid—along with salt to enhance flavor and a high glycemic carbohydrate load creates a very different physiological response.

High-glycemic carbohydrates produce rapid glucose and insulin spikes. Since hyperglycemia is something the body works hard to correct, these foods trigger significant physiological responses.

When you combine high calories, high saturated fat, high-glycemic carbohydrates, relatively little fiber, and added salt, those foods become much more likely to stimulate the brain’s reward system. Participants consistently identified foods with those characteristics as more addictive.

That really resonated with me personally.

As a child, I used to wonder why I kept choosing foods like Lunchables, Slim Jims, and Slurpees instead of celery with peanut butter or cottage cheese. I thought it was simply a matter of making better choices.

Looking back, I realize my environment—and the way those foods were engineered—made those choices much more difficult than I understood at the time. Those dopamine and serotonin pathways were being activated in ways I didn’t recognize.

NP:

Absolutely.

That’s such an important point because it changes how we think about patient care.

When we discuss the clinical implications in future episodes, I think it’s critical that we approach patients with compassion and recognize they’re often facing sophisticated biochemical manipulation designed to encourage repeated consumption.

Just like nicotine and other addictive substances, these foods create positive feedback loops in some of the deepest reward centers of the brain—the pathways we all learned about in medical school but probably haven’t thought much about since.

Understanding those mechanisms is essential if we’re going to understand food addiction.

GC:

I’m really glad you made that connection.

In medical school, we’re often taught to tell patients, “Choose this instead of that,” or “Eat less of this.” But for many people, it’s not that simple.

One tool I think clinicians should know about is the Yale Food Addiction Scale (YFAS). It’s a validated screening instrument that helps identify patients who may be experiencing addictive eating behaviors.

It’s freely available online and can help clinicians determine which patients may benefit from additional support, whether that’s closer follow-up, behavioral counseling, or consultation with specialists in addiction medicine.

Just as we recognize alcohol or tobacco addiction, it’s important to acknowledge that food addiction may also be playing a significant role in a patient’s health.

I’m glad you brought up how we can apply this clinically because I think it’s an important step forward.

NP:

Absolutely.

We’ll include a link to the Yale Food Addiction Scale in the show notes because it’s a fascinating tool. It’s quick, practical, and fits into clinical workflows much like the PHQ-9 or GAD-7.

These screening tools help us better understand our patients. Since people develop their relationships with food for many different reasons, understanding that context can make a tremendous difference in clinical care.

For this episode, though, we’re staying focused on the science.

The American Journal of Public Health recently released this landmark collection of studies. About a year earlier, The Lancet published what many considered a groundbreaking series on ultra-processed foods—something many described as a major challenge to the ultra-processed food industry.

I’d love to hear your perspective on why these publications are so important, what they found, and why this conversation is happening now.

GC:

The Lancet series was truly groundbreaking. You and I had the opportunity to discuss it publicly last year.

What I appreciated most was that it elevated the global conversation around public policy and ultra-processed foods.

Originally, food processing was largely about preservation. We needed ways to keep food fresh long enough to transport it from producers to consumers.

As globalization expanded, however, preserving fresh food became increasingly expensive.

I remember my parents joking that Twinkies used to be real cakes. Now one can sit on a shelf for years and still look exactly the same. Even today, I sometimes look at a loaf of bread that’s been sitting on my counter for two weeks and wonder why it still looks fresh.

We’ve shifted from asking, “How do we preserve food?” to asking, “How do we produce food as cheaply as possible while making it highly appealing to consumers?”

If inexpensive products expire, relatively little is lost. If they’re consumed in large quantities, they’re highly profitable.

The Lancet highlighted how this shift has contributed to obesity and chronic disease around the world.

The American Journal of Public Health then expanded that discussion by examining the specific techniques behind flavor engineering and food design. It explored how chemical processes and even pharmaceutical-style delivery methods have been incorporated into food to make products more appealing and satisfying.

I hear this from patients all the time.

They’ll tell me, “Dr. Cox, my weakness is chips.”

When I ask why, many say it isn’t even the flavor—it’s the crunch.

That crunch isn’t accidental. It’s the result of years of scientific research focused on creating a specific sensory experience that people continue to crave.

I also want to recognize Dr. Laura Schmidt from the University of California, San Francisco (UCSF), who authored one of the key papers in this collection. She deserves tremendous credit for the attention this work has received.

Her paper examined how quality improvement methods and research strategies developed by the tobacco industry were later applied to the food industry.

She described consumer focus groups involving children and parents, where researchers explored what families wanted from convenient foods—products that were fun, appealing, convenient, and perceived as healthy.

Companies then used those findings to shape both product development and marketing strategies.

To me, the American Journal of Public Health publication is a natural continuation of the conversation that The Lancet started.

I’m excited to see more research like this because I think the public is finally beginning to pay attention.

NP:

Absolutely. When you see two highly respected journals dedicate entire issues to this topic, it speaks to the growing momentum behind addressing the global health crisis associated with poor nutrition and ultra-processed foods.

I’m encouraged that this issue is finally receiving the attention it deserves.

I also think we should address the elephant in the room. Much of this conversation overlaps with the Make America Healthy Again (MAHA) initiative from the U.S. Department of Health and Human Services under Robert F. Kennedy Jr., as well as messaging coming from the CDC.

What’s challenging is separating the politics from the policy and the underlying philosophy.

As a clinician, I think many people share the same basic concern. Most people don’t walk through a grocery store feeling completely confident about the food they’re buying. Parents don’t want to worry about infant formula recalls or wonder whether the foods they’re bring home are truly healthy for their families.

There’s been a real erosion of trust in the food supply.

Now, as a pediatrician, my views on vaccines are well known, and they’re grounded in established public health evidence. There are certainly aspects of the MAHA movement where I disagree. But when it comes to concerns about the food supply, I think many people—regardless of politics—share the same underlying desire for healthier, more trustworthy food.

Food dyes, for example, have become a major focus of HHS. There are areas where many of us can agree, even if we don’t agree on every issue.

GC:

I think that’s exactly why this moment is so important.

Many people have grown frustrated with the status quo. Rather than describing it as a lack of FDA oversight, I’d say there are aspects of the current regulatory framework and terminology that deserve to be updated.

For example, a product may be labeled as containing “natural flavors” because the flavor compound originated from a plant or animal source, even if the final ingredient is highly processed and chemically isolated.

Using our truffle example, a flavor compound could be extracted from a plant that isn’t a truffle, concentrated, added to oil, and labeled as a natural flavor. Technically, that may satisfy current definitions, but it isn’t necessarily what consumers believe they’re purchasing.

What Robert F. Kennedy Jr. has done is bring tremendous public attention to these issues.

Whether people agree with every aspect of his agenda or not, it’s clear that consumers are paying attention.

As you mentioned earlier, people don’t feel comfortable walking down the aisle filled with brightly colored chips, sodas, and cereals. We instinctively recognize that many of those foods aren’t particularly healthy.

At the same time, I think there’s both excitement and uncertainty within the medical community. People are asking what changes might come next.

Some recent policy decisions—such as changes to vaccine recommendations—have generated significant debate within medicine.

At the same time, it’s worth remembering that Robert F. Kennedy Jr. spent much of his career as an environmental attorney.

When I look at today’s food environment, I see an environmental health issue. We’ve lost control of large portions of our food supply, and that’s affecting what ultimately reaches our dinner tables.

My hope is that this renewed focus on obesity and chronic disease will encourage a closer examination of how foods are produced, marketed, and labeled.

Perhaps it’s even a conversation worth sharing more broadly. We need thoughtful discussions about updating terminology, improving transparency, reducing consumer confusion, and allowing people to make informed choices—while still respecting both consumer choice and business innovation.

Ultimately, everyone should have the opportunity to make informed decisions about the food they buy.

NP:

Absolutely.

What you’re really describing is advocacy.

Whether we’re talking about policy, education, or updating regulations, this is an important opportunity to improve transparency and help consumers better understand what these terms actually mean.

There’s a real opportunity right now to encourage companies to represent their products more clearly and honestly.

In public health, we often talk about the “Overton window”—the range of policy ideas that are politically possible at a given moment.

Regardless of how people feel about Robert F. Kennedy Jr.’s style or rhetoric, he has brought sustained attention to this topic, and that has created an opportunity for broader conversations about food policy.

I’d like to close by talking about the broader impact of ultra-processed foods. From a policy perspective, what have we learned so far, and what evidence do we have regarding their effects on health?

GC:

It’s a challenging conversation because there’s so much happening in the world right now.

Many families are facing financial pressures, increased stress, and growing mental health challenges. Economic hardship has also increased reliance on programs such as SNAP and WIC to help families put food on the table.

As a pediatrician, you’ve undoubtedly seen firsthand how social determinants of health affect families’ ability to maintain healthy lifestyles.

We’ve also continued to refine our dietary recommendations over the years. There is still room for improvement, and nutrition science continues to evolve.

My hope is that policymakers—including Congress and HHS—remain open to the growing body of evidence surrounding nutrition and ultra-processed foods.

We have an opportunity to strengthen dietary guidance, improve food labeling, and encourage healthier food systems.

At the same time, I don’t think this is about punishing or banning companies. People should always retain the freedom to choose what they eat.

Instead, I’d like to see greater investment in public health, nutrition, prevention, and healthier product development.

Healthcare benefits everyone, and I believe industry can play an important role in improving population health.

We can learn from the business strategies that helped build these industries and apply those same lessons to create better public policy and healthier communities.

To me, this feels like a rare opportunity. There is momentum from the public, healthcare professionals, researchers, and policymakers. If we work together, we have a real chance to make meaningful progress.

NP:

I love that perspective, and I especially appreciate the optimism.

Optimism has been in short supply in public health lately, so it’s encouraging to focus on the opportunities ahead.

Dr. Cox, thank you for joining me on The Podcast for Doctors (By Doctors).

In our next episode, we’ll focus on the clinical implications of ultra-processed foods. We’ll also be joined by a registered dietitian to discuss how clinicians can apply this information in patient encounters, improve counseling, and explore additional policy considerations.

Be sure to join us for that conversation.

Thank you again for being here.

GC:

Thank you, Dr. Palmer. It’s truly been a pleasure speaking with you and sharing this information with our listeners. I look forward to our next conversation.

NP:

You can catch The Podcast for Doctors (By Doctors) on Apple, Spotify, YouTube, and all major platforms. If you enjoyed this episode, please rate and subscribe. Next time you see a doctor, maybe prescribe this podcast. See you next time.

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