Red Dye, Rhetoric, and Reality: MAHA Model’s Oversimplified Cure for America’s Health Woes

The Commission on Making American Health Again (MAHA) recently held its first closed-door meeting, racing toward an August deadline set by President Trump’s executive order. Its mission? To slash chronic disease rates and overhaul America’s approach to nutrition, lifestyle, and medication. 

But for most of us, MAHA is more of a vibe than a coherent policy framework. The publicly obvious MAHA model is simple: food is medicine. But this is more of a deconstruction of chicken soup, emphasizing the salt rather than the comfort. What are the underlying principles of the MAHA mom’s approach? According to President Trump’s executive order, MAHA is to refocus

“toward understanding and drastically lowering chronic disease rates and ending childhood chronic disease.  This includes fresh thinking on nutrition, physical activity, healthy lifestyles, over-reliance on medication and treatments, the effects of new technological habits, environmental impacts, and food and drug quality and safety.”

Like other public health measures, the Commission's recommendations will become mandates and regulations. For those desiring “medical freedom,” it is unclear how MAHA’s mandates will be less abusive of autonomy than concerns over masking, vaccines, or abortions. The MAHA model’s strengths and weaknesses lie in its simplicity. However, simplicity is not particularly good at representing reality. 

Food is medicine makes the same reductive mistake as focusing on nutrients over foods. A less reductive, more holistic model of our food environment may provide better policy guidance. 

Evolutionary Imperatives

Human biology evolved under conditions of scarcity, not abundance. Our bodies are hardwired to crave calorie-dense foods and avoid unnecessary exertion. Functional traits in a hunter-gatherer world are problematic when movement is optional and food is everywhere. 

We need water to control our body temperature, flush waste products, and deliver nutrients. We can survive roughly 3 to 5 days without water. However, food, which is necessary for energy and a source of bodily structure and function, is a more resilient need; we can starve for weeks. 

Moreover, as omnivores eating plants and animals, we are culinary generalists, lacking the specialization of a speedy predator and the plant-digestion efficiency of ruminants. Our biological fitness, honed from a millennium of scarcity, has tuned our “tastes” toward sweets and fatty food, energy-dense food options, urging us to feast when possible, allowing our metabolism to store the excess for a bad day’s hunt or harvest. 

Humans at rest remain at rest. 

Taking it easy when you didn't have to exert yourself was an adaptation. It's useful. It's good. But now, of course, we have this very strange modern world where we no longer have to be active at all. And now we have to do the reverse, we have to choose to be active and we never evolved to do that.” [emphasis added]

- Daniel Lieberman, Professor of Human Evolution and Biology, Harvard 

Lions, apex predators, are opportunistic hunters, often sleeping 15 to 21 hours daily. Our ancestral hunter-gatherers were similarly adapted, believed to put in a little over 2 hours of moderate exertion daily in activity necessary for survival. 

Recent research into non-exercise activity thermogenesis (NEAT) suggests that our urge to move might be a biological drive, like hunger or thirst, shaped by our environment, internal biology, and even our stage of life. Children are more active than adults, and adults become increasingly sedentary as they age. 

The MAHA model does contain a kernel of truth. Today’s food systems are at odds with our biological inheritance. Our food ecosystem, with a diet appealing to our biological drives, a large proportion of which is factory-based, “ultra-processed” foods, is associated with several nutrition-related noncommunicable diseases – diabetes and cardiovascular disease being the most prominent. Food is medicine delivers on the emotional concern but lacks explanatory power to guide change. 

Nutritional Transition

A better model accounts for the nutrition transition—the global shift from undernutrition and infectious disease to chronic, diet-related illnesses. This transition reflects massive structural forces, not simply the food on our plates. A nutrition transition model incorporates transitions in our demographics and health and their entanglements, resulting in complex underlying determinants that shape our food environment and nutritional outcomes. 

Globally, no countries remain in Stage 1, collecting food, or Stage 2, with episodic famine; famine today is primarily the result of armed conflict or natural disasters. Many low- and middle-income countries (LMIC) are in Stage 3. There is increasing consumption of fruits, vegetables, and animal proteins and diminished emphasis on starchy staples. The rapid transition to a “Western diet” [1] often results in a double burden of malnourished and overnourished individuals. Lagging public health measures leave them with both communicable and rising noncommunicable diseases. 

Like other high-income countries, the US sits in Stage 4, where nutrition-related noncommunicable diseases are predominant, and the most effective target of food is medicine. The fifth stage, an aspirational food is medicine’s nirvana, sees food consumption revert to whole, minimally processed foods. However, to achieve that, we need a better understanding of the non-biological drivers of the food environment. 

Ultra-Processed Foods - The Great Satan

Historically, food processing and nutrition have remained separate scientific endeavors. MAHA living in the abundance of Stage 4, unconcerned with undernutrition, is placing a stronger emphasis on a food-health balance. “Super-foods” have been supplanted by food as medicine.

“Food processing” generally refers to actions altering a food from its natural state, such as drying, freezing, milling, canning, or adding salt, sugar, fat, or other additives for flavor or preservation. Food processing has always been about making food safe, stable, and transportable. Fire and early cooking unlocked calories and nutrients. The Industrial Revolution brought innovations in pasteurization, sterilization, and refrigeration. With a growing abundance of food due to hybridization and farm automation, preservation provided a platform for additional processing aimed at palatability, convenience, and indulgence, driven by additives, packaging, and shelf-life science.

Food processing has been characterized in several ways. The most well-known is the NOVA classification, distinguishing between processed and unprocessed foods. While increasingly used as a proxy for nutrition, the classification does not reference processing or nutritional value. It focuses on the extended amounts of sugar, salt, fat, and additives in industrial-process foods. 

“It becomes clear from the examples in NOVA that the distinction between unprocessed or minimal processed food products and ultra-processed foods boils down to whether they are produced through home cooking/culinary art or on an industrial scale.”

The CHEFS model provides a broader, more aligned lens for evaluating food systems, addressing five key forces: 

Convenience – the time economy of grab-and-go foods, including freezing and canning

Health – claims of “super-foods” and avoidance of food-borne disease

Epicurean/emotions – the sensory delight we experience with food

Function – the role of food as a cultural signal

Sustainability – the human organization of a food chain and its environmental impacts

Non-nutrient Forces

Over the last half-century, numerous factors have driven shifts in our diet. 

• Declines in physical activity, often from automation and appliances, reduced manual labor and created more leisure time, which is a positive. Modern sedentary leisure, e.g., our love affair with screens, driven by our biological desire to conserve energy, has compounded health issues. Increasing activity is important but is not the primary driver of long-term nutritional change.
• Urbanization, has multiple dimensions and remains a powerful influence on dietary and activity patterns. It involves migration, labor shifts, infrastructure, and income growth. Migration to cities, driven by economic necessity and opportunity, has fueled the growth of sprawling settlements. Urban populations are particularly vulnerable to the nutrition transition due to better food distribution, lower physical work demands, and evolving household dynamics, e.g., single-parent families. Many rural areas now exhibit these urban traits, contributing to rising obesity outside cities.
• Globalized food markets have changed what foods are available and affordable., Increased imports and changing agricultural priorities have made processed foods cheaper and easier to obtain in all countries, creating a further imbalance between energy intake and output.
• Rising incomes allow a trade-off of more time for less money, altering eating habits towards more food consumed away from home, increased snacking, and grab-and-go convenience. Ultra-processed foods (UPFs) offer the same time-saving option, often at lower cost.
• Labor force participation has impacted women’s gender roles in food preparation. Women who are balancing their jobs and home duties are particularly susceptible to the rising time costs of food preparation, which results in changes in diet and food preparation.
• Technology has reshaped everything from cooking to commuting. Labor-saving home appliances and mechanized agriculture have reduced human energy expenditure. For example, in 1900, 40% of the population was engaged in agriculture; today, less than 2% produces 5-fold more. Entertainment technology has replaced active leisure for both kids and adults. Transportation improvements have replaced walking and moving heavy loads.
• Government farm policies often favor “commodity crops,” like sugar, corn, and wheat, neglecting “specialty crops,” like fruit and vegetables, that offer better nutrition. Similar patterns apply to meat and dairy subsidies, skewing food systems away from healthier options.
• The food industry has fueled significant changes. In response to market demand, often boosted by advertising, manufacturers have developed high-margin, cheap, ultra-processed foods. They have also resisted food reformulation, except for touting food fortification. Like the other “Bigs,” they have used regulatory capture to influence health and nutrition policymaking and governance. 

All these environmental changes work synergistically to create an “obesogenic” environment. People are constantly surrounded by inexpensive, tasty, energy-dense options, making excessive calorie intake almost the default. The spread of the Western diet and nutrition-related chronic illness is the product of structural changes in how food is produced, sold, and consumed. 

Carrot Sticks

In the end, the MAHA model’s greatest flaw is mistaking a slogan for a solution. “Food is medicine” may soothe anxieties and inspire Instagram posts, but it lacks the precision, scope, and humility required to tackle our modern health crisis's messy, entangled drivers. Our biology evolved for scarcity; our food system evolved for efficiency and profit. Somewhere in between lies the challenge—and it won’t be solved with bans on Red Dye No. 3 or lectures on kale. Those easy wins are “a tale, full of sound and fury, signifying nothing.” A serious effort to “Make American Health Again” must go beyond pantry policing and acknowledge the structural realities of labor, technology, policy, and inequality that shape what we eat, how we move, and who gets sick. If MAHA hopes to offer more than performative reform, it must trade moral posturing for systems thinking—and learn that real change doesn’t come pre-packaged or sugar-free.

[1] The Western diet is a bit of a misnomer. While most associated with the US and Europe, all countries converge on this food ecosphere, often tailored to account for cultural and dietary needs and desires.  

Sources: The Nutrition Transition: An Overview of World Patterns of Change Nutrition Reviews DOI: 10.1111/j.1753-4887.2004.tb00084.x

Food Processing at a Crossroad Frontiers in Nutrition DOI: 10.3389/fnut.2019.00085

Behind the  creative destruction  of human diets: An analysis of the structure and market dynamics of the ultra-processed food manufacturing industry and implications for public health Journal of Agrarian Change DOI: 10.1111/joac.12545