The Leading Voices in Food Duke World Food Policy Center

Traditional clinical weight loss interventions can be costly, time consuming, and inaccessible to low-income populations and people without adequate health insurance. Today's guest, Dr. Gary Bennett, has developed an Interactive Obesity Treatment Approach, or iOTA for short, that represents a real advance in this area. Dr. Bennett is Professor of Psychology and Neuroscience, Medicine and Global Health at Duke University, where he is also Dean of Trinity College of Arts and Sciences.
Interview Summary
You know, in this time when people are talking about more expensive, and kind of more intrusive interventions, like the big weight loss drugs, it's nice to know that there may be alternatives that could be accessible to more people. Could we start off with you telling our listeners what the iOTA approach is and how it works?

Sure. This is an approach for weight management. It's useful for weight loss or preventing weight gain or maintaining one's weight after you've lost weight. The idea here is that it's a technology that's designed to be highly accessible, and useful for a range of different types of populations. So, as you described, we have developed and tested this primarily for folks who are medically vulnerable, who are low income, who are racial, ethnic minority, who live in rural communities, and where we have traditionally had real difficulty reaching populations with effective weight loss tools. So, iOTA is a fully digital approach. It uses technologies smartphone apps, but it can also use text messaging, interactive voice response, those are like robocalls, automated telephone calls, websites. We've tested this on a wide range of different types of technology platforms, and we've tested it in a range of different types of populations all over the country and indeed even in other countries.

So, give us some examples of what kind of information people might be receiving through these various forms of media.

The underlying kind of technology, the underlying approach, I should say, for iOTA is actually reasonably simple. It operates from the perspective that creating weight loss is really about making an energy deficit. That is to say, helping people to consume fewer calories than they are expending. The realization we had years ago is that you can get there, you can create that calorie deficit in a whole host of different ways. Some people diet, some people try to get more active, there are limitations around that kind of approach. But fundamentally, you can also just get there by asking people to do some reasonably straightforward behaviors. Like not consuming sugary beverages, or consuming fewer chips, cookies and candies. Or changing the amount of red meat that they put on the plate. And, if you frame those things out as goals, then you can prescribe those goals to people in ways that make sense to them personally. The trick though is actually in the idea of personalizing those goals to the given individual. And that's where technology comes in and gets very helpful. The case is, if you have a large library of these goals, you'd want to try to provide these in a highly personalized way. That really are aligned with what people's needs are and noting that those needs may change over time. So, what we do with iOTA is deliver a very short survey. That survey then helps us to be able to look into our library of goals and pick the ones that are most useful for our users. We prescribe those goals, and then we ask folks to self-monitor those goals. Self-monitoring or tracking is an extraordinarily powerful part of behavior change science. And so, we ask them to track using one of our technologies: the chat bot or the text message or interactive voice response or the smartphone app. Every time that we receive data from one of our users, we give them highly personalized feedback that is designed around principles of behavior change science. And then over time we also give them support. We do support sometimes from

Fast food is part of American life. As much a part of our background as the sky and the clouds. But it wasn't always that way, and over the decades, the fast food landscape has changed in quite profound ways. Race is a key part of that picture. A landmark exploration of this has been published by today's guest, Dr. Naa Oyo Kwate. She is an Associate Professor in the Department of Africana Studies and the Department of Human Ecology at Rutgers University. Her book, recently published, is entitled White Burgers, Black Cash: Fast Food From Black Exclusion to Exploitation. The book has been received very positively by the field. And was recently named the best book in the field of urban affairs by the Urban Affairs Association.
 
Interview Summary
I was so happy to see your book because people have talked about the issue of race off and on in the field, but to see this kind of scholarly treatment of it like you provided has been really a welcome addition. Let me start with a general question. Let's begin with the fast food situation today and then rewind to where it began. Are there patterns to where fast food restaurants are located and who fast food is marketed to?

Absolutely. There's quite a bit of research, and you just alluded to the work that's been done in the field. There's a lot of research that shows fast food is most dense in African American communities. Not every study has the same finding, but overall that's what the accumulated evidence shows. On the one hand you have the fact that Black communities are disproportionately saturated with these outlets. Then there's also the case that apart from the physical locations of the restaurants, fast food is strongly racialized as Black in terms of how it's portrayed to the public. It [Fast Food] relies on images of Blackness and Black cultural productions such as Black music for its marketing. These sometimes these veer into racial caricature as well. One of the things I talked about in the book briefly is the TV commercial character Annie who Popeye's introduced in 2009. They basically created this Black woman that Adweek at the time was calling "feisty," but it's really just this stereotypical idea of the sassy Black woman and she's in the kitchen frying up the chicken for Popeye's. And actually, some of the language that was used in those commercials really evokes the copy on late 19th century and Aunt Jemima pancake mix packaging. It's a really strong departure from fast food's early days, the way that fast food is now relying on Blackness as part of its core marketing constructs.

I'm assuming that it follows from what you've been saying that the African American community has disproportionately been targeted with the marketing of these foods. Is that true of children within that community?

Research shows that in terms of fast food marketing at the point of purchase. There's more - display advertising for example at restaurants that are in Black communities. And then there's also been research to show, not in terms of the outlets themselves, but in terms of TV programming that there tends to be more commercials for fast food and other unhealthy foods during shows that are targeting Black youth.

How much of the patterning of the fast food restaurants is due to income or due to the amount of fast food consumption in these areas with many restaurants?

Almost none of it really. It's not income and it's not the amount of fast food that people are consuming. In fact, one of the main studies that led me to start researching this book, because I was coming to it from public health where there was a lot of research around the disproportionality of fast food restaurants. We actually did a study in New York City, some colleagues and we published it in 2009, where we looked at how fast food was distributed across New York City's five boroughs. And restaurant density, we found, was due almost entirely to racial demographics. There's very little contribution from

A growing number of research studies show that the cognitive and brain development of low-income children differs from that of children in higher income families. For any family, that is a concerning statement. Today's podcast features a project called Baby's First Years, a multi-year effort to test the connections between poverty reduction and brain development among very young children. Here to talk about what the study has revealed so far is Dr. Lisa Gennetian from Duke University's Sanford School of Public Policy, and Dr. Sarah Halpern-Meekin from the La Follette School of Public Affairs at the University of Wisconsin, Madison.
Transcript
Sarah, let's start with you. What is the Baby's First Years study?
 
Sarah - So the Baby's First Years study is a study of how having additional income matters for children's development and for family life in families that had incomes around the federal poverty line when they had a child. And so, it includes two main components. The first is a randomized control trial that tests the effects of families receiving either a large or a small monthly cash gift each month, families get either $333 or $20 each month on a debit card from the time their child was born until just after the child's sixth birthday. Lisa and our colleagues, Katherine Magnuson, Kimberly Noble, Greg Duncan, Hiro Yoshikawa, and Nathan Fox lead this part of the study. They've been following mothers and children from a thousand families over the past six years. The other part of the study is a qualitative study in which we do in-depth interviews with a subset of those families because we want to learn more about how they think, about making financial decisions, the values and dreams for their children that guide their parenting and how they think about their money they're getting from Baby's First Years each month.

This study is complex and would require time to observe change. Can you tell me about the length of time your team has been doing this intervention?

Sarah - So the first families started the study in 2018.

Lisa - One thing that's unique about this intervention is its length. As Sarah mentioned, it's starts at the time of birth and it's monthly. And families will be receiving this cash for 76 months. So, they'll be receiving it through the first six years of their child's life.

Thank you for that detail. Lisa, what is the landscape for food programs and assistance in the United States, particularly for families with infants and young children?

Lisa - There are two major programs that are federally funded in the US that are particularly targeted for families with infants and children. One of them is called the Women, Infant, and Children's Program, or WIC for short. The WIC program, let's see, in 2022, served about 6.3 million participants, but it provides a mix of core nutritional needs, breastfeeding support, information and referrals. And the second big safety net program in the US around food is called SNAP, Supplemental Nutrition Assistance Program. This one's broader and has served over 40 million people in 2022. And together both these programs have been pretty core to providing food and nutritional support to families, including those with young children.

Thanks for that context. So now, how does the cash gift intervention differ from, or fit with other food assistance programs that these families may participate in?

Lisa - The thing that cash can add above and beyond that, so thinking about how this Baby's First Year study might help supplement resources is in two ways. One is thinking about how money that might have been spent on the foods that are provided by these programs are now being taken care of through these food subsidies. One direct way that the BFY cash money can help is by increasing those net resources available for other types of food or for other things in the household. It's a real compliment to these what we call in kind or conditioned kind of food subsidy p

Today's podcast is a story of one man's personal journey to making a difference by building communities. Zach Wyatt grew up caretaking an old 300-acre farm in Virginia. He went to college and ended up working in mortgage lending. And then something changed for Zack, and that's where the story gets interesting. He now leads the Carolina Farm Trust, working to strengthen local food systems in the Carolinas. The trust cultivates urban farm networks, farm apprenticeships, supports local farmers in purchasing equipment or land, making informed-decisions, and more.
Interview Summary

I'd like to understand a little bit more, why did you want to start the Carolina Farm Trust?

Well, with a lot of things, it was just kind of by accident and circumstance. And I would say subconsciously I had agriculture in my bones, ever since I was a kid growing up in agriculture in Northern Virginia. It just kind of seeps in. We [The Family] still have that little arm reached out to being a part the DC metro area. Growing up in an urban-rural environment kind of planted, I think, a lot of the seeds in the work that was going to transpire so many decades later. But it really just kind of came down to a life event. I had a partnership that just ended in one day, which was a huge blow to us financially. We had to get on EBT and Snap and went through that process. And I was really soul searching and figuring out what were the next steps for me. Looking back on it, I think I was really grasping on to how do I do anything, to kind of just do something. I got back into reading about our food system and farms and started meeting some farmers. And once you start talking to farmers in a real way and understanding what our food system truly is, it's horrifying. It kind of came down to seeing this visual metaphor of a meteorite heading toward us every day, and either sticking your head in the sand or doing something. Circumstance just led to this next event and next event, and the next event. And eight years later, here we are.

What I hear from you is this story of resiliency and it seems like that's something you also see in the food system or a need for that is that a fair assessment?
 
Absolutely. We just take food in agriculture for granted. And over the last 80 to 90 years, we've really given our entire means of survival pretty much away. Most people don't really look at food and agriculture and how it spins every major decision on Earth. Every social problem we typically have, every health issue we have, if you follow it all the way down to where that problem started, you go all the way back to the dirt. So, to kind of look at resilience and what do we mean by that and more importantly, building regional resilience in a global economy: I think getting supply chains a whole lot shorter, focusing on soil health and nutrition density and our farming community, is where we really have to start.

I'm starting to get a sense of the big picture of the farm trust. What is the driving mission of your work? I think you're hitting on some of that, but I'd like to hear more.

I'd say the vision is very clearly about building regional resilience and then using food and agriculture as a primary driver. The four main pillars we have are health and nutrition, upward mobility and equity, sustainability, and climate change. Our four action-on-the-ground pillars are first, building an urban farm network and to get people to understand where our food comes from. Why is that important? We do really need to push urban centers to be more responsible for where our food comes from and playing a role in that. Second, our farm apprentice program, workforce development. You know, the average age of our farming community right now is a little over 60. Where is this next generation of farmers coming from? Where is the land coming from? So, it is not only kind of a labor force for us, you know, but how do we make sure every community garden, every school garden is th

If people knew how much food they threw away each week, would they change their food-wasting ways? That's a question scientists explore in the 2023 State of Food Waste in America report. The research goal was to understand why and how households waste food, and what would motivate them to prevent food waste. In today's podcast, we'll talk with MITRE scientists Laura Leets and Grace Mika, members of a team who developed and launched the MITRE Food Waste Tracker app. This is a first of its kind app for households to log information about discarded food and learn ways to save money by reducing food waste. The Food Waste in America study team includes the Gallup Survey Company, researchers from the Ohio State University, the Harvard Law and Policy Clinic, ReFED, the Natural Resources Defense Council, and the World Wildlife Fund.
Interview Summary
 
Laura, let's begin with you. Can you give us a quick overview of why MITRE focused on measuring food waste at the household level and the behaviors?

Laura - In a general sense, Norbert, we know the United States waste 30 to 40% of our food, yet we do not know how much is wasted at the household level. We know that waste occurs along the entire farm to table supply chain, like approximately 15% with farms, 15% at manufacturing, about 20% at stores and restaurants and about 50% in the household. So, given that half the waste happens at the household level, it's important to measure it. If you can measure it, you can do something about it. Up to this point, people have not had an easy way to estimate their amount of food waste. So, to address this gap, not only did we develop a new way to measure household food waste and Grace will share more about that, but we also provided a baseline measurement of American household food waste.

I would like to really dig in a little bit more. How much food do American households waste, and do you have a sense of what kinds of foods people are wasting?

Laura - Let me start with the amount first. We found that the average American household wastes somewhere from 3 to 4.5 pounds per week. And there's two ways to measure household food waste. The first is you can focus on the edible or uneaten food. And with this measure, American households waste about on average three pounds per week. Second, you can add inedible food. So, that's your food scraps, your eggshells. And if you take edible plus inedible food together, then the American households wastes on average about 4.5 pounds per week. Let me give your listeners a couple analogies to understand that impact of that 3 to 4.5 pounds of household food waste. So, let's say we combine our own household food waste with everyone else's. The crop waste is large enough to cover the states of California and New York. From a personal perspective, imagine before every meal you scrape off 40% of the food on your plate. If you imagine that in each meal, you're going to start to understand that the current food waste is massive, and we're all contributing to it. So that's the measurement piece. I'm going to pass it over to Grace to discuss the types of food we're wasting.

Grace - Americans are wasting a wide variety of foods in their homes, but the number one wasted food type is your fresh produce. So, that would be your fruits and your vegetables.

I think this is really important to keep in mind, not only because, of course, fruits and vegetables are perishable, but when we think about healthy diets, many people in the nutrition space are encouraging fresh fruits and vegetables or fruits and vegetables in general. Ao this is a really important finding, and I'm excited to know this. But it's also important for our listeners to think a little bit more about this. Grace, I would like to learn a little bit more from you. Can you tell us more about the MITRE Food Waste Tracker, the app itself?

Grace - I would be happy to. The MITRE Food Waste Tracker app is meant to be a tool for households who wa

Dollar stores are the fastest growing food retailer in the United States, both by sheer number of stores and consumer food purchases. Just two corporations, Dollar General and Dollar Tree, which also owns Family Dollar, operate more than 35,000 stores across the country. However, a growing body of research reveals that dollar stores offer limited healthy food options. Dollar stores shape the food environments of communities, especially in the South and Midwest regions and communities in rural areas with substantial shares of Black and Latin people and households with limited financial resources. What do we know about the impact dollar stores have on these communities and the overall wellbeing of community members? The Center for Science in the Public Interest conducted a national survey to understand how people perceive and actually use dollar stores. Today we will talk with lead author of this study, Senior Policy Scientist Sara John.
Interview Summary

My first question is what do we know about dollar stores and healthy food access?

There are more than 35,000-dollar stores across the country. So, to put that large number into context for people like me who have trouble processing them, that's more dollar stores than McDonald's, Starbucks and Walmarts combined. As you also mentioned, just two companies, Dollar General and Dollar Tree, control nearly all of them. Dollar stores really play a large role in food acquisitions for households. They can be especially important for households with limited incomes and those living in rural communities. These smaller store formats are much smaller than your typical grocery store or supermarket and tend to stock fewer fresh and healthy items. So, the body of evidence is still growing and we're still trying to figure out really how dollar stores interact with the food environment, whether or not they're driving out existing or potential new grocery stores or whether they're filling important food gaps in communities that otherwise lack food access.

I am really blown away by the number. I must admit I did not appreciate that they have 35,000 stores across the US. I know that there is a growing body of literature, as you suggested. One of our colleagues, Sean Cash at Tufts has been working in this space along with others in various disciplines have been thinking about the role of dollar stores. I'm interested to understand why CSPI conducted a national survey of those or perceptions, and what were some of the key findings?

As I mentioned, there's a lot of outstanding questions we still don't know. There have been more than 50 communities across the country that have already passed policies at the local level to ban or improve new dollar stores in their communities. But we don't understand community perceptions, usage and just I guess more plainly what people want from dollar stores. So, CSPI really wanted to take a stance to make policy, corporate, and research recommendations on this very quickly and growing retail format. But before doing so, we wanted to really make sure that we're centering our recommendations around what community members really want from dollar stores. We decided to conduct a national survey. We ended up having over 750 respondents from across the country of people with limited financial resources that lived near a dollar store. I have to say we were pretty surprised by our findings, especially given this popular sentiment that we have seen in the news media and with a lot of the local policy action. I would say that we found overall positive dollar store perceptions that people really are relying on dollar stores for food. But I would say just as many people want them to make healthy foods more available, affordable, and accessible.

Could you help me understand how did people find them beneficial? What were some of the things that you discovered, in terms of the benefits? But I'd like to also hear what were the points of contention? Where did they w