By Grace Hussain for Sentient.
Broadcast version by Shanteya Hudson for Georgia News Connection reporting for the Sentient-Public News Service Collaboration
Robert F. Kennedy Jr.’s confirmation as Director of Health and Human Services — the government department that oversees the Food and Drug Administration and the Center for Disease Control among others — could be another damper for the plant-based food market. Through his “Make America Healthy Again” campaign, Kennedy has repeatedly argued that processed foods are poisoning the country, a stance he maintained throughout his confirmation hearings. And because processed foods aren’t well defined, any efforts by RFK to restrict ultra-processed foods could end up inadvertently discouraging U.S. consumers from eating plant-based foods. That would be bad news for the already-struggling plant-based industry, but also for climate change and the environment.
Though he did not support an all-out ban on processed foods during his confirmation hearing, Kennedy expressed his support for restricting school purchasing and limiting SNAP beneficiaries’ ability to purchase processed foods. While both SNAP and federal school purchases are managed by the U.S. Department of Agriculture and thus would be outside of Kennedy’s direct control, the Department of Agriculture and the Department of Health and Human Services both work closely on food policy.
Now that he’s approved, Kennedy could push for a range of policies for reducing the country’s consumption of processed foods, including the FDA’s labeling requirements.
“Warning labels and taxes tend to change people’s behavior. So if you put a warning label on a product, people, on average, are a little bit less likely to buy that product. If you tax a product, people are a little bit less likely to buy it. It’s because it’s a little bit more expensive, so I would expect that those policies, if implemented, would reduce how much we eat those products,” Anna Grummon, who runs the Stanford Food Policy Lab, tells Sentient.
Defining Ultra-Processed Foods Proves Difficult
One of the factors that makes legislating processed foods difficult is the fact that not all processed foods are created equal. Some processed foods, such as sugary beverages like soda, have been linked to various health issues including diabetes and obesity. But that’s not the case for all processed foods, including plant-based meats.
The expansive category that is “processed foods” is why some policymakers and activists zeroed in on a new label: ultra-processed foods. But here too, there’s no single definition of what exactly constitutes an ultra-processed food. “That’s a challenge for making policy around ultra-processed foods,” says Grummon. “We have to have a definition we agree on, and that can be implemented by policymakers and by companies.”
Currently, the most prominent definition comes from the NOVA Food Classification System, which was proposed by researchers at the University of São Paulo. Under the system, ultra-processed foods are combinations of ingredients that are not whole foods themselves, or are “synthesized in laboratories.”
Another definition, appearing on the conservative organization Center for Renewing America’s website, notes a few factors in its definition of ultra-processed foods, including “packaged foods containing added preservatives,” and “manufactured ingredients…that extend the shelf-life of a product, enhance the taste of the product, and often result in habit-forming cravings…” (The founder of the organization was part of the first Trump Administration, and previously signaled his intent to defund the EPA, while also pushing transphobic rhetoric.)
The specific definition RFK Jr. prefers, and which would likely be replicated by the FDA, remains unclear. Regardless of the specifics of the definition, it’s unlikely to cleanly identify the least healthy foods, simply because all ultra-processed foods are not the same.
Some policies have addressed this problem by regulating nutrients, rather than the level of processing. For example, in Chile, products high in calories, sodium, sugar or saturated fat are required to have warning labels on the front of their packaging, and can’t be sold or served in schools. The approach has significantly cut how often those foods are purchased, though it doesn’t seem to have curbed obesity rates. In fact, the BBC reports obesity has increased among school children slightly since 2016 (though this may be attributable to an increase in sedentary lifestyles during COVID-19).
Policies focused on nutrient content “gets at ultra-processed foods indirectly,” says Grummon. The FDA is currently considering a rule that would require most foods to sport front-of-package nutrient labeling, ultra-processed or not.
Potential Health & Environmental Impacts of Ultra-Processed Labeling
Warning labels on ultra-processed foods sound like a good idea, but when it comes to plant-based meat, these labels could indirectly lead to negative environmental and public health impacts if consumers were to cut back on their plant-based eating habits as a result. Potential taxes that increase the cost of ultra-processed plant-based meats, like Impossible and Beyond products, are also likely to reduce the amount of those products consumers purchase, says Grummon.
“A key question is what do people switch to? Do they switch back to beef? Or do they switch to something else?,” she says. “That’s really important for understanding whether those policies would be good or bad for public health or good or bad for carbon footprint. I think if people switch back to beef, that’s not going to be good for carbon emissions, because, of course, beef has a much higher carbon footprint than Beyond and Impossible products.”
The average person in the United States already eats far more meat than the global average. For that reason and because of beef’s massive greenhouse gas emissions impact, climate research groups like the World Resources Institute include the recommendation that U.S. (and other global north) consumers eat less beef as part of their climate action plan for food-related emissions.
When researchers compare beef to plant-based alternatives, the alternatives consistently rank better, using less water and land and emitting far fewer greenhouse gasses. Other types of meat — like poultry and pork — are more moderate for greenhouse gas emissions, yet both are associated with poor animal welfare and polluting the air and water of communities that live near factory farms.
Even when looking at personal health, plant-based alternatives tend to perform as well as or slightly better than meat. Despite being categorized as ultra-processed, plant-based alternatives tend to be a little lower in fat and calories, and sometimes have more fiber than meat. On the other hand, meat tends to have less sugar and more protein per serving, and of course, individual products do vary.
If policies aimed at rolling back consumption of ultra-processed foods are enacted, many plant-based alternatives will likely be impacted, given that they’d be considered ultra-processed under the most prominent definition. “You can imagine some things being bad for sustainability, like people might eat fewer meat mimic[king] products, like Beyond and Impossible, because those are ultra-processed,” says Grummon.
A representative of The Plant Based Foods Association declined to comment for this article, stating, “given the potential regulatory outcomes are still unknown, we’d prefer not to comment at this time.”
The Bottom Line
It is possible that new policies targeting ultra-processed foods could persuade consumers to opt for more legumes over plant-based burgers or conventional meat. But given how often most U.S. consumers regularly eat lentils these days, it seems unlikely.
A new food labeling scheme could also make no difference at all. One study found that Swiss consumers already view meat substitutes as processed, regardless of the form they take; so it’s also a possibility that consumers willing to purchase plant-based alternatives won’t be swayed by new policies.
Ultimately, what policies RFK and the Trump Administration might pursue on processed and ultra-processed foods remain hard to predict, Grummon says. But many plant-based products are categorized as ultra-processed under any definition. Even if plant-based foods aren’t a particular target of policies aimed at sugary beverages or candy bars, regulatory language that focuses on the processing — instead of nutrient content — would likely end up including plant-based alternatives. These sorts of policies then could spell more trouble ahead, both for the plant-based market and the planet.
Grace Hussain wrote this article for Sentient.
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As Republican lawmakers in Washington, D.C., consider cuts to Medicaid, a new report has found thousands of veterans in Virginia could be affected.
Virginia passed Medicaid expansion in 2018, which broadened who qualified for the program, including people under 65 and without children who make 138% or less of the federal poverty level. The report by The Commonwealth Institute showed more than 47,000 Virginia veterans receive health coverage through Medicaid.
Freddy Mejia, policy director at the institute, said work requirements or cuts to the Medicaid expansion would increase barriers to Virginians' access to health care.
"We just kind of want to raise the profile of how federal cuts to Medicaid could impact not only hundreds of thousands of Virginians, nearly 629,000 Virginians that have health coverage through Medicaid expansion, but also to veterans in particular here in Virginia," Mejia outlined.
Rep. Mike Johnson, R-La., the Speaker of the House, has said the Medicaid expansion under the Affordable Care Act allowed people who did not truly need the benefit to enroll. Republicans have called for major cuts in spending across the federal government but are split on which entitlement programs should be trimmed, and by how much.
Virginia is one of eight states with what is known as an automatic trigger law in place, where states would immediately end their expansion if the federal government lowers its funding of the Medicaid expansion below 90%.
Mejia argued veterans in the Commonwealth would get caught up in the cuts.
"If the federal government decides to reduce funding for Medicaid expansion by even 1%, our state law means that it would automatically end Medicaid expansion," Mejia pointed out. "That would immediately throw potentially thousands of veterans off of coverage."
More than 20% of Virginians access health care through Medicaid.
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By Brett Kelman for KFF Health News.
Broadcast version by Freda Ross for Arkansas News Service reporting for the KFF Health News-Public News Service Collaboration
In the wooded highlands of northern Arkansas, where small towns have few dentists, water officials who serve more than 20,000 people have for more than a decade openly defied state law by refusing to add fluoride to the drinking water.
For its refusal, the Ozark Mountain Regional Public Water Authority has received hundreds of state fines amounting to about $130,000, which are stuffed in a cardboard box and left unpaid, said Andy Anderson, who is opposed to fluoridation and has led the water system for nearly two decades.
This Ozark region is among hundreds of rural American communities that face a one-two punch to oral health: a dire shortage of dentists and a lack of fluoridated drinking water, which is widely viewed among dentists as one of the most effective tools to prevent tooth decay. But as the anti-fluoride movement builds unprecedented momentum, it may turn out that the Ozarks were not behind the times after all.
"We will eventually win," Anderson said. "We will be vindicated."
Fluoride, a naturally occurring mineral, keeps teeth strong when added to drinking water, according to the Centers for Disease Control and Prevention and the American Dental Association. But the anti-fluoride movement has been energized since a government report last summer found a possible link between lower IQ in children and consuming amounts of fluoride that are higher than what is recommended in American drinking water. Dozens of communities have decided to stop fluoridating in recent months, and state officials in Florida and Texas have urged their water systems to do the same. Utah is poised to become the first state to ban it in tap water.
Health and Human Services Secretary Robert F. Kennedy Jr., who has long espoused fringe health theories, has called fluoride an "industrial waste" and "dangerous neurotoxin" and said the Trump administration will recommend it be removed from all public drinking water.
Separately, Republican efforts to extend tax cuts and shrink federal spending may squeeze Medicaid, which could deepen existing shortages of dentists in rural areas where many residents depend on the federal insurance program for whatever dental care they can find.
Dental experts warn that the simultaneous erosion of Medicaid and fluoridation could exacerbate a crisis of rural oral health and reverse decades of progress against tooth decay, particularly for children and those who rarely see a dentist.
"If you have folks with little access to professional care and no access to water fluoridation," said Steven Levy, a dentist and leading fluoride researcher at the University of Iowa, "then they are missing two of the big pillars of how to keep healthy for a lifetime."
Many already are.
Overlapping 'Dental Deserts' and Fluoride-Free Zones
Nearly 25 million Americans live in areas without enough dentists - more than twice as many as prior estimates by the federal government - according to a recent study from Harvard University that measured U.S. "dental deserts" with more depth and precision than before.
Hawazin Elani, a Harvard dentist and epidemiologist who co-authored the study, found that many shortage areas are rural and poor, and depend heavily on Medicaid. But many dentists do not accept Medicaid because payments can be low, Elani said.
The ADA has estimated that only a third of dentists treat patients on Medicaid.
"I suspect this situation is much worse for Medicaid beneficiaries," Elani said. "If you have Medicaid and your nearest dentists do not accept it, then you will likely have to go to the third, or fourth, or the fifth."
The Harvard study identified over 780 counties where more than half of the residents live in a shortage area. Of those counties, at least 230 also have mostly or completely unfluoridated public drinking water, according to a KFF analysis of fluoride data published by the CDC. That means people in these areas who can't find a dentist also do not get protection for their teeth from their tap water.
The KFF Health News analysis does not cover the entire nation because it does not include private wells and 13 states do not submit fluoride data to the CDC. But among those that do, most counties with a shortage of dentists and unfluoridated water are in the south-central U.S., in a cluster that stretches from Texas to the Florida Panhandle and up into Kansas, Missouri, and Oklahoma.
In the center of that cluster is the Ozark Mountain Regional Public Water Authority, which serves the Arkansas counties of Boone, Marion, Newton, and Searcy. It has refused to add fluoride ever since Arkansas enacted a statewide mandate in 2011. After weekly fines began in 2016, the water system unsuccessfully challenged the fluoride mandate in state court, then lost again on appeal.
Anderson, who has chaired the water system's board since 2007, said he would like to challenge the fluoride mandate in court again and would argue the case himself if necessary. In a phone interview, Anderson said he believes that fluoride can hamper the brain and body to the point of making people "get fat and lazy."
"So if you go out in the streets these days, walk down the streets, you'll see lots of fat people wearing their pajamas out in public," he said.
Nearby in the tiny, no-stoplight community of Leslie, Arkansas, which gets water from the Ozark system, the only dentist in town operates out of a one-man clinic tucked in the back of an antique store. Hand-painted lettering on the store window advertises a "pretty good dentist."
James Flanagin, a third-generation dentist who opened this clinic three years ago, said he was drawn to Leslie by the quaint charms and friendly smiles of small-town life. But those same smiles also reveal the unmistakable consequences of refusing to fluoridate, he said.
"There is no doubt that there is more dental decay here than there would otherwise be," he said. "You are going to have more decay if your water is not fluoridated. That's just a fact."
Fluoride Seen as a Great Public Health Achievement
Fluoride was first added to public water in an American city in 1945 and spread to half of the U.S. population by 1980, according to the CDC. Because of "the dramatic decline" in cavities that followed, in 1999 the CDC dubbed fluoridation as one of 10 great public health achievements of the 20th century.
Currently more than 70% of the U.S. population on public water systems get fluoridated water, with a recommended concentration of 0.7 milligrams per liter, or about three drops in a 55-gallon barrel, according to the CDC.
Fluoride is also present in modern toothpaste, mouthwash, dental varnish, and some food and drinks - like raisins, potatoes, oatmeal, coffee, and black tea. But several dental experts said these products do not reliably reach as many low-income families as drinking water, which has an additional benefit over toothpaste of strengthening children's teeth from within as they grow.
Two recent polls have found that the largest share of Americans support fluoridation, but a sizable minority does not. Polls from Axios/Ipsos and AP-NORC found that 48% and 40% of respondents wanted to keep fluoride in public water supplies, while 29% and 26% supported its removal.
Chelsea Fosse, an expert on oral health policy at the American Academy of Pediatric Dentistry, said she worried that misguided fears of fluoride would cause many people to stop using fluoridated toothpaste and varnish just as Medicaid cuts made it harder to see a dentist.
The combination, she said, could be "devastating."
"It will be visibly apparent what this does to the prevalence of tooth decay," Fosse said. "If we get rid of water fluoridation, if we make Medicaid cuts, and if we don't support providers in locating and serving the highest-need populations, I truly don't know what we will do."
Multiple peer-reviewed studies have shown what ending water fluoridation could look like. In the past few years, studies of cities in Alaska and Canada have shown that communities that stopped fluoridation saw significant increases in children's cavities when compared with similar cities that did not. A 2024 study from Israel reported a "two-fold increase" in dental treatments for kids within five years after the country stopped fluoridating in 2014.
Despite the benefits of fluoridation, it has been fiercely opposed by some since its inception, said Catherine Hayes, a Harvard dental expert who advises the American Dental Association on fluoride and has studied its use for three decades.
Fluoridation was initially smeared as a communist plot against America, Hayes said, and then later fears arose of possible links to cancer, which were refuted through extensive scientific research. In the '80s, hysteria fueled fears of fluoride causing AIDS, which was "ludicrous," Hayes said.
More recently, the anti-fluoride movement seized on international research that suggests high levels of fluoride can hinder children's brain development and has been boosted by high-profile legal and political victories.
Last August, a hotly debated report from the National Institutes of Health's National Toxicology Program found "with moderate confidence" that exposure to levels of fluoride that are higher than what is present in American drinking water is associated with lower IQ in children. The report was based on an analysis of 74 studies conducted in other countries, most of which were considered "low quality" and involved exposure of at least 1.5 milligrams of fluoride per liter of water - or more than twice the U.S. recommendation - according to the program.
The following month, in a long-simmering lawsuit filed by fluoride opponents, a federal judge in California said the possible link between fluoride and lowered IQ was too risky to ignore, then ordered the federal Environmental Protection Agency to take nonspecified steps to lower that risk. The EPA started to appeal this ruling in the final days of the Biden administration, but the Trump administration could reverse course.
The EPA and Department of Justice declined to comment. The White House and Department of Health and Human Services did not respond to questions about fluoride.
Despite the National Toxicology Program's report, Hayes said, no association has been shown to date between lowered IQ and the amount of fluoride actually present in most Americans' water. The court ruling may prompt additional research conducted in the U.S., Hayes said, which she hoped would finally put the campaign against fluoride to rest.
"It's one of the great mysteries of my career, what sustains it," Hayes said. "What concerns me is that there's some belief amongst some members of the public - and some of our policymakers - that there is some truth to this."
Not all experts were so dismissive of the toxicology program's report. Bruce Lanphear, a children's health researcher at Simon Fraser University in British Columbia, published an editorial in January that said the findings should prompt health organizations "to reassess the risks and benefits of fluoride, particularly for pregnant women and infants."
"The people who are proposing fluoridation need to now prove it's safe," Lanphear told NPR in January. "That's what this study does. It shifts the burden of proof - or it should."
Cities and States Rethink Fluoride
At least 14 states so far this year have considered or are considering bills that would lift fluoride mandates or prohibit fluoride in drinking water altogether. In February, Utah lawmakers passed the nation's first ban, which Republican Gov. Spencer Cox told ABC4 Utah he intends to sign. And both Florida Surgeon General Joseph Ladapo and Texas Agriculture Commissioner Sid Miller have called for their respective states to end fluoridation.
"I don't want Big Brother telling me what to do," Miller told The Dallas Morning News in February. "Government has forced this on us for too long."
Additionally, dozens of cities and counties have decided to stop fluoridation in the past six months - including at least 16 communities in Florida with a combined population of more than 1.6 million - according to news reports and the Fluoride Action Network, an anti-fluoride group.
Stuart Cooper, executive director of that group, said the movement's unprecedented momentum would be further supercharged if Kennedy and the Trump administration follow through on a recommendation against fluoride.
Cooper predicted that most U.S. communities will have stopped fluoridating within years.
"I think what you are seeing in Florida, where every community is falling like dominoes, is going to now happen in the United States," he said. "I think we're seeing the absolute end of it."
If Cooper's prediction is right, Hayes said, widespread decay would be visible within years. Kids' teeth will rot in their mouths, she said, even though "we know how to completely prevent it."
"It's unnecessary pain and suffering," Hayes said. "If you go into any children's hospital across this country, you'll see a waiting list of kids to get into the operating room to get their teeth fixed because they have severe decay because they haven't had access to either fluoridated water or other types of fluoride. Unfortunately, that's just going to get worse."
Brett Kelman wrote this story for KFF Health News.
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