OK, these seven words include key phrases in the debate on how to develop a meaningful policy on healthy eating. It turns out that there is a dialogue script between those who support such policies and those who don’t. These words and phrases come from a recent book, Healthy Eating Policy and Political Philosophy: A Public Reason Approach, by Anne Barnhill and Matteo Bonotti. The discussion is timely in light of the recent White House Conference on Hunger, Nutrition, and Health. FDA is following up the conference in a quest to codify its results. And the seven words, with apologies to George Carlin, are:

1. Autonomy is “the ability to act rationally based on one’s (true and authentic) desires.” In this context it is the freedom to eat what we want to eat. Conflicting with food freedom are limited access to healthy food in food deserts. The large proportion of Americans on low-calorie diets suggests a desire to eat healthier. Would restrictions on processed and ultra-processed foods represent a threat to personal food autonomy? Does the marketing of products by Big Food overwhelm personal autonomy? Should the federal government take on the responsibility of developing policies to promote healthy eating?

2. Cultural relevance reflects “experiences that are valuable to individuals because they are part of the cultural context that provides them with options for their exercise of individual autonomy.” We embrace cultural practices associated with specific foods as children and carry them throughout our lives. At times we may cling to foods reflecting family traditions. At other times we may turn to current food fashion in a desire to fit in. Some personal practices are considered healthy by society and others not-so-much. How can we balance our cultural heritage with our desire to eat healthy meals? How much pressure is placed on us and our families from food beliefs imposed by predominant groups within society? Are healthy eating guidelines biased against minority cultures?

3. Life plans are “longer-term, stable, structured plans for a life.” What are our inner motivations that move us forward? What are our long-term goals? Do they get to the heart of personal autonomy? Do they help direct daily decisions or are they merely theoretical? Do we live our lives based on our long-term goals or are we overwhelmed with concerns of daily life? How often do we think about our health? How often do we associate our health with the food we eat?

4. Paternalism is the treatment of different groups by the government for their own good. Paternalism can become coercive if it “eliminates choices or mandates certain actions (g., laws banning the sale of cigarettes or limiting portion sizes in fast-food restaurants).” Limiting choices of unhealthy foods eligible for SNAP (food stamps) or in food pantries can be considered paternalistic. Does this interfere with autonomy or is it better for the health of recipients and their families? Does paternalism ignore cultural relevance?

5. Public reason “appeal[s] to ‘the methods and conclusions of science when these are not controversial’ or to ‘plain truths now widely accepted, or available, to citizens generally.’” Policymakers must determine that the relevant science is not controversial, and that conventional wisdom represents plain truths. For example, not all food professionals believe that processed foods, even ultra-processed foods, are inherently unhealthy. Airports are notorious for offering quick, not so healthy, foods to professionals trying to make their flight connections. Should we shut down the unhealthiest options in the terminals? Or would that be a paternalistic violation of personal autonomy?

6. Rationality is the idea “central to a positive conception of freedom.” Again, policymakers must decide what is rational and what is for the greater good. Specific beliefs by a religion, ethnic groups, industry, or other entity are not considered. So much for cultural relevance. Alternative perspectives among scientists should be considered but such challenges to ‘plain truths’ can be overridden by policymakers. Political considerations must be weighed as supporters of one major party may be at odds with the decision. Such a dilemma faced the decisions to make Covid vaccines mandatory during the pandemic.

7. Tradeoffs occur despite our “best effort to navigate dilemmas surrounding food.” Family time in the evenings can interfere with home meal preparation. Road trips can force a choice between fast-food and full-service restaurants. Are such tradeoffs rare diverging from an otherwise healthy dietary pattern or do they become more of the rule than the exception? Could governmental policy help nudge us in the right direction without becoming too paternalistic and violating our personal autonomy? 

Resolving conflicts between principles. Balancing these perspectives becomes a challenge for public policymakers. Food processors might consider all healthy-eating guidelines to be paternalistic and interfering with food freedom. Advocates for healthy eating may view the greater good for society a valid reason for overriding some personal autonomy. For example, one perspective suggests that “we want longer lives and we want good health as ends in themselves and as means to doing everything else we want to do.” Rationality suggests that since we all want to live long, healthy lives government has an obligation to promote healthy eating. But do habits promoting health and longevity fit into our life plans? Or do desires for pleasure, social acceptance, fame, riches, time consciousness, or professional advancement lead to tradeoffs that interfere with healthy eating practices on a daily basis?   

Take home lesson. Food is something we experience every day. What we eat, when we eat it, and how much we eat are personal considerations we face daily. What role does government need to play in helping us to make wiser choices? Would the benefits of guiding a significant proportion of the population to better health outweigh infringement of food freedom of others? These are not easy issues to resolve. Barnwell and Bonotti provide specific considerations in evaluating healthy eating policies. Policymakers must state the public health goals of a specific program and assess the effectiveness of achieving them. They must also identify potential burdens, how to minimize them, and propose ways to balance benefits and burdens.

Coming soon: The Kiss ☠️ Test by Linn Steward