In response to recent reports from the Centers for Disease Control and Prevention (CDC), authors of an opinion piece in JAMA are advocating for changes in policy and an aggressive campaign using both the mass media and social media to reduce the consumption of unhealthy foods in the United States.

Two CDC reports noted that between 2015 and 2016, the prevalence of obesity in adults reached 39.6% and in youth reached 18.5%; this is in contrast to levels of 15% for adults and 5.5% for youth between 1976 and 1980. Obesity is associated with increases in hypertension, stroke, myocardial infarction, cancers, and type 2 diabetes, as well as an estimated 386,000 excess deaths per year. Sodium consumption also is at an all-time high, with mean sodium consumption reaching approximately 4000 mg/d, which is 1.5 times the recommended daily maximum of 2300 mg. Excess sodium consumption is associated with increases in hypertension, myocardial infarction, and stroke and may cause as many as 92,000 excess death per year.

Michael F. Jacobson, PhD, of the Center for Science in the Public Interest, Washington, DC, and colleagues recommend taxing sugar-sweetened beverages and note that such taxes have been passed in more than 25 countries, as well as a number of US cities. These taxes have also been associated with a 9.7% decrease in consumption of these beverages in Mexico, with greater declines found in lower-income households. They also advocate reducing sodium levels in processed foods.

Additionally, several nations have limited the allowable sodium content of key foods, and the United Kingdom and Canada have implemented voluntary sodium-reduction targets for many categories of foods. In 2016, the US Food and Drug Administration (FDA) proposed voluntary targets in approximately 150 food categories, and these should be finalized by 2019.

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Still, Dr Jacobson and colleagues note that although these efforts are laudable, they need to be accompanied by efforts by government agencies such as the FDA to pressure companies to reach the targets. Furthermore, they argue that the US Department of Agriculture should reduce sodium in school lunches without further delay.

The authors suggest other measures to improve nutrition and reduce diet-associated disease, such as requiring simpler nutrition labels on packaging that alerts consumers to the potential adverse effects of certain foods, eliminating marketing of unhealthy food to children, and increasing subsidies to low-income individuals for the purchase of healthy foods such as fruits and vegetables. This last suggestion could be paid for at least in part by the sugar tax. Finally, as the US population receives one-third of its calories from food consumed outside the home, the authors recommend more informative labeling on menus and regulated standards of nutrition for restaurant meals that are heavily marketed to children.


Jacobson MF, Krieger J, Brownell KD. Potential policy approaches to address diet-related diseases [published online June 28, 2018]. JAMA. doi:10.1001/jama.2018.7434