The Leading Voices in Food

By: Duke World Food Policy Center
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  • Summary

  • The Leading Voices in Food podcast series features real people, scientists, farmers, policy experts and world leaders all working to improve our food system and food policy. You'll learn about issues across the food system spectrum such as food insecurity, obesity, agriculture, access and equity, food safety, food defense, and food policy. Produced by the Duke World Food Policy Center at wfpc.sanford.duke.edu.
    Duke World Food Policy Center
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Hygiene & Healthy Living Science Social Sciences
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Episodes
  • E259: Your state of the science on weight loss drugs

    E259: Your state of the science on weight loss drugs
    Jan 9 2025
    About two years ago, we released a podcast with Dr. Thomas Wadden of the University of Pennsylvania describing work on a new generation of medications to treat diabetes and obesity. They were really taking the field by storm. Since then, much more is known since many additional studies have been published and so many people have been using the drugs. So many, in fact, the market value of the Danish company, Novo Nordisk, one of the two major companies selling the drugs, has gone up. It is now greater than the entire budget of the country of Denmark. This single company is responsible for about half of Denmark's economic expansion this year. So, a lot of people are now taking the drugs and this is a great time for an update on the drugs. And we're fortunate to have two of the world's leading experts join us: Dr. Wadden, Professor of Psychology and Psychiatry at the University of Pennsylvania School of Medicine and the inaugural Albert J. Stunkard Professor of Psychiatry at Penn. Joining us as well as Dr. Robert Kushner, a physician and professor of medicine at Northwestern University and a pioneer in testing treatments for obesity. Interview Summary Tom, you and I were colleagues at Penn decades ago. And I got frustrated the treatments for obesity didn't work very well. People tended to regain the weight. And I turned my attention to prevention and policy. But you hung in there and I admired you for that patience and persistence. And Bob, the same for you. You worked on this tenacious problem for many years. But for both of you, your patience has been rewarded with what seems to me to be a seismic shift in the way obesity and diabetes can be treated. Tom, I'll begin with you. Is this as big of a deal as it seems to me? Well, I think it is as big of a deal as it seems to you. These medications have had a huge impact on improving the treatment of type 2 diabetes, but particularly the management of obesity. With older medications, patients lost about 7 percent of their starting weight. If you weighed 200 pounds, you'd lose about 15 pounds. That was also true of our best diet and exercise programs. You would lose about 7 percent on those programs with rigorous effort. But with the new medications, patients are now losing about 15 to 20 percent of their starting body weight at approximately one year. And that's a 30-to-40-pound loss for a person who started at 200 pounds. And with these larger weight losses, we get larger improvements in health in terms of complications of obesity. So, to quote a good friend of mine, Bob Kushner, these medications have been a real game changer. Thanks for putting that in perspective. I mean, we're talking about not just little incremental changes in what treatments can produce, which is what we've seen for years. But just orders of magnitude of change, which is really nice to see. So, Bob what are these medications that we're talking about? What are the names of the drugs and how do they work? Well, Kelly, this transformation of obesity really came about by finding the target that is really highly effective for obesity. It's called the gut brain axis. And when it comes to the gut it's starting off with a naturally occurring gut hormone called GLP 1. I think everyone in the country's heard of GLP 1. It's released after we eat, and it helps the pancreas produce insulin, slows the stomach release of food, and reduces appetite. And that's where the obesity story comes in. So pharmaceutical companies have taken this hormone and synthesized it, something similar to GLP 1. It mimics the action of GLP 1. So, you could actually take it and give it back and have it injected so it augments or highlights this hormonal effect. Now, that same process of mimicking a hormone is used for another gut hormone called GIP that also reduces appetite. These two hormones are the backbone of the currently available medication. There's two on the market. One is called Semaglutide. That's a GLP 1 analog. Trade name is Wegovy. Now, it's also marketed for diabetes. Tom talked about how it is used for diabetes and increases insulin. That trade name is Ozempic. That's also familiar with everyone around the country. The other one that combined GLP 1 and GIP, these two gut hormones, so it's a dual agonist, the trade name for obesity is called Zep Bound, and the same compound for diabetes is called Mounjaro. These are terms that are becoming familiar, I think, to everyone in the country. Tom mentioned some about the, how much weight people lose on these drugs, but what sort of medical changes occur? Just to reiterate what Tom said, I'll say it in another way. For Semaglutide one third of individuals are losing 20 percent of their body weight in these trials. For Tirzepatide, it even outpaces that. And I got a third of individuals losing a quarter of their body weight. These are unheard of weight losses. And with these weight losses and these independent effects from weight, what we're seeing in the trials ...
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    42 mins
  • E258: Do 'market driven epidemics' drive your food choices?

    E258: Do 'market driven epidemics' drive your food choices?
    Dec 19 2024
    For much of history, the word 'epidemic' applied to infectious diseases. Large numbers of cases of disease caused by organisms such as bacteria and viruses that spread through water, air, or other means, sometimes transmitted from person to person, or back and forth between people and animals. Then came epidemics of chronic diseases such as obesity, diabetes, heart disease - diseases occurring in very large numbers and created not by infectious agents, but by drivers in our day to day lives, such as a bad food environment. A new paper was just published in the PLOS global health literature that I found fascinating. It focuses on another use of the concept of epidemics: market driven epidemics. Let's find out what these are and find out a little bit more about their implications for our health and wellbeing. Our guests today are two of the authors of that paper. Dr. Jonathan Quick is a physician and expert on global health and epidemics. He is an adjunct professor at Duke University's Global Health Institute. Eszter Rimanyi joins us as well. She works on chronic disease and addiction epidemiology at Duke university. Interview Summary Access the PLOS article “Dynamics of combatting market-driven epidemics: Insights from U.S. reduction of cigarette, sugar, and prescription opioid consumption.” So, Jono, let's start with you. Tell us what you mean by market driven epidemics. The pattern is familiar to people. There is a product that that humans like and the business community says we can make a lot of money on this unmet need. And so they do that and they start selling a lot of it. And then people start noticing that this thing that the humans like is killing some of them. And so, the scientists do the public health. And then the business community says these scientists are going to kill the golden goose. They buy up other scientists and try to defend themselves. And then it goes on and on before we really bend the epidemic curves. This pattern of consumer products that have harmful effects, those products are major contributors to the root causes of at least a million deaths a year in the US, and over 20 million deaths worldwide. So, to try to look at this from an epidemic point of view, we first established a case definition. Our definition of market driven epidemic is a significant increase in death, disability and other harmful effects on humans and human health and wellbeing. It's arising from a consumer product whose use has been accelerated by aggressive marketing. Whose harmful effects have been denied or otherwise minimized by producers. And for which effective mitigation is possible but actively opposed by producers. So, we looked at the natural history of this, and we found five phases through which these epidemics pass. There's market development, either inventing a new product, developing a product like prescription opioids, or transforming an existing product like tobacco. Phase two is evidence of harm. First, there's suspicion, astute clinicians, whistleblowers, and then eventually proof of harm. Phase three is corporate resistance. Companies deny harm, seek to discredit accusers, commission counter science, manufacture doubt, mount legal challenges. All the while deaths and social upheaval and economic costs are mounting. And finally, our next phase four is mitigation. We get some regulatory efforts going, and there's a tipping point for the consumption and resulting deaths. And then finally, phase five of this is market adaptation. In a response to decreasing or threatened consumption, companies and consumers typically seek alternatives. Adaptations can be positive or negative. Some are healthier, some are equally or more harmful. Thanks very much for that description. It really helps explain what the concept is all about. You chose three areas of focus. You could have chosen others, but you chose cigarettes, sugar, and prescription opioid use. Why those in particular? We wanted to identify differences in these market driven epidemics in a few product categories. We wanted to look at distinctly different consumer experiences so we could see what worked and what didn't in terms of bending the epidemic curve. We picked nicotine delivery, food, and prescription medicine. And to choose within those categories we established five inclusion criteria. So, number one, the product had to have proven adverse health effects. Number two, there needed to be well documented histories of product development, marketing, mitigation efforts, and so forth. Number three, the product needed to meet the overall case definition. That is, companies knew they were doing harm, continued to do harm, and fought that harm. Number four, there needed to be long term data available for product consumption and associated impact. And number five, most important, we chose products for which mitigation efforts had already resulted in significant sustained reduction in product consumption. Based on these three criteria, ...
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    29 mins
  • E257: Embracing convergence in the RECIPES Network

    E257: Embracing convergence in the RECIPES Network
    Dec 4 2024
    In 2021, American University and 15 partner institutions across the U. S. launched the Multiscale RECIPES Research Network with the goal of transforming our wasted food system into a sustainable and resilient one. Food loss and waste is a complex problem spanning societal issues such as food insecurity and food recovery, sustainable farming, food packaging and transportation, food marketing, sales and consumer preferences, family dynamics, and corporate profits, among others. A fascinating part of the RECIPES Network vision is a purposeful focus on convergence, making the research process more effective and creative in designing solutions to big problems such as these. In a recent article in the journal Ecology and Society, team members evaluated how well the network's intentional convergence efforts have worked thus far. Interview Summary Norbert Wilson - It is my great pleasure to welcome my colleague, Amanda Wood, who is a research scientist at the World Food Policy Center. Amanda Wood - Thank you, Norbert. I'm looking forward to this discussion today. Our guests come from the University of Illinois Institute of Technology Food Systems Action Lab. Weslynne Ashton is a professor of environmental management and sustainability at Illinois Tech and co directs the Food Systems Action Lab. Azra Sungu is a design researcher and strategist at the Food Systems Action Lab, who just defended her doctoral dissertation. So, our biggest congratulations to Dr. Sungu. Thank you so much for being here today. So first, I want to start by saying the RECIPES Network has gone about their work a little bit differently than most traditional academic projects by taking a convergence approach. Weslynne, would you talk about what convergence is in research, and why is this approach useful for tackling complex societal challenges like food waste? Weslynne Ashton - Convergence is an approach that really tries to integrate the best of many different disciplines. The way that they see, approach, and tackle problems. And tries to integrate them in a really holistic way, right? Like, we often operate in silos and universities and this is a way of trying to get out of that. But more than working side by side on the same topics, it really tries to pull ways of working and ways of knowing across these different disciplines. For the topic of food waste, which as Norbert described is incredibly complex, right? There are so many different dimensions. They're scientific, natural science, social science, anthropological, political science. So, there are these technical aspects, economic aspects, social aspects, as well as cultural and spiritual aspects that we really don't talk about that often. And so, a convergence approach tries to say, how can we bring together the way all of these different disciplines approach understanding and developing solutions so that the solutions we develop can be more holistic. And more likely to take hold because they are considering these different perspectives. Amanda - A lot of individuals might not see food waste as this complex challenge. They throw their leftovers in the bin and that's food waste to them. But as you say, challenges of food waste and food loss extend all the way across the food system. So, we definitely need that more holistic approach. Thanks for that bigger picture. Norbert, over to you. Norbert - Azra, I'd like to turn it over to you and ask you a question about design. And I've got to say, this is the first project that I've ever worked on where I've worked with design scholars. And so, I'm excited for you to share with our audience what actually is design. And how do you see design fitting in the context of the work that we've been doing? Azra Sungu - Thank you. Yes, it's been very exciting for me to part of such a transdisciplinary group as well. And probably in over 12 years of design education that I got, that was the most frequent question. Like my family and everyone that's asking, like, what is it that you do actually? So, I think it's really important that we clarify that because design in this context is a little bit different than the design of products and services. In a way, we could say that it carries similar principles, but in recent years, design has been gaining visibility as a creative and collaborative problem-solving approach. So, some of the key mindsets, methods, and processes of design have been distilled into more accessible toolkits that allow more people from various backgrounds and expertise to get together and collaboratively explore problems of different kinds and approach them in more creative ways. So, we can say that, yeah, this adaptation of design found applications in different fields, such as entrepreneurship. We see that picking up in education or even apply to issues related to social justice. And I would say that what makes it different from other problem-solving approaches is that it centers a deep understanding of humans, their needs, their ...
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    33 mins

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