E284: The Science of How Food Both Nourishes and Harms Us

An avalanche of information besets us on what to eat. It comes from the news, from influencers of every ilk, from scientists, from government, and of course from the food companies. Super foods? Ultra-processed foods? How does one find a source of trust and make intelligent choices for both us as individuals and for the society as a whole. A new book helps in this quest, a book entitled Food Intelligence: the Science of How Food Both Nourishes and Harms Us. It is written by two highly credible and thoughtful people who join us today.Julia Belluz is a journalist and a contributing opinion writer for the New York Times. She reports on medicine, nutrition, and public health. She's been a Knight Science Journalism Fellow at MIT and holds a master's in science degree from the London School of Economics and Political Science. Dr. Kevin Hall trained as a physicist as best known for pioneering work on nutrition, including research he did as senior investigator and section chief at the National Institutes of Health. His work is highly regarded. He's won awards from the NIH, from the American Society of Nutrition, the Obesity Society and the American Physiological Society.

Interview Transcript

Thank you both very much for being with us. And not only for being with us, but writing such an interesting book. I was really eager to read it and there's a lot in there that people don't usually come across in their normal journeys through the nutrition world. So, Julia, start off if you wouldn't mind telling us what the impetus was for you and Kevin to do this book with everything else that's out there.

Yes, so there's just, I think, an absolute avalanche of information as you say about nutrition and people making claims about how to optimize diet and how best to lose or manage weight. And I think what we both felt was missing from that conversation was a real examination of how do we know what we know and kind of foundational ideas in this space. You hear a lot about how to boost or speed up your metabolism, but people don't know what metabolism is anyway. You hear a lot about how you need to maximize your protein, but what is protein doing in the body and where did that idea come from? And so, we were trying to really pair back. And I think this is where Kevin's physics training was so wonderful. We were trying to look at like what are these fundamental laws and truths. Things that we know about food and nutrition and how it works in us, and what can we tell people about them. And as we kind of went through that journey it very quickly ended up in an argument about the food environment, which I know we're going to get to.

We will. It's really interesting. This idea of how do we know what we know is really fascinating because when you go out there, people kind of tell us what we know. Or at least what they think what we know. But very few people go through that journey of how did we get there. And so people can decide on their own is this a credible form of knowledge that I'm being told to pursue. So Kevin, what do you mean by food intelligence?

Coming from a completely different background in physics where even as we learn about the fundamental laws of physics, it's always in this historical context about how we know what we know and what were the kind of key experiments along the way. And even with that sort of background, I had almost no idea about what happened to food once we ate it inside our bodies. I only got into this field by a happenstance series of events, which is probably too long to talk about this podcast. But to get people to have an appreciation from the basic science about what is going on inside our bodies when we eat. What is food made out of? As best as we can understand at this current time, how does our body deal with. Our food and with that sort of basic knowledge about how we know what we know. How to not be fooled by these various sound bites that we'll hear from social media influencers telling you that everything that you knew about nutrition is wrong. And they've been hiding this one secret from you that's been keeping you sick for so long to basically be able to see through those kinds of claims and have a bedrock of knowledge upon which to kind of evaluate those things. That's what we mean by food intelligence.

It makes sense. Now, I'm assuming that food intelligence is sort of psychological and biological at the same time, isn't it? Because that there's what you're being told and how do you process that information and make wise choices. But there's also an intelligence the body has and how to deal with the food that it's receiving. And that can get fooled too by different things that are coming at it from different types of foods and stuff. We'll get to that in a minute, but it's a very interesting concept you have, and wouldn't it be great if we could all make intelligent choices? Julia, you mentioned the food environment. How would you describe the modern food environment and how does it shape the choices we make?

It's almost embarrassing to have this question coming from you because so much of our understanding and thinking about this idea came from you. So, thank you for your work. I feel like you should be answering this question. But I think one of the big aha moments I had in the book research was talking to a neuroscientist, who said the problem in and of itself isn't like the brownies and the pizza and the chips. It's the ubiquity of them. It's that they're most of what's available, along with other less nutritious ultra-processed foods. They're the most accessible. They're the cheapest. They're kind of heavily marketed. They're in our face and the stuff that we really ought to be eating more of, we all know we ought to be eating more of, the fruits and vegetables, fresh or frozen. The legumes, whole grains. They're the least available. They're the hardest to come by. They're the least accessible. They're the most expensive. And so that I think kind of sums up what it means to live in the modern food environment. The deck is stacked against most of us. The least healthy options are the ones that we're inundated by. And to kind of navigate that, you need a lot of resources, wherewithal, a lot of thought, a lot of time. And I think that's kind of where we came out thinking about it. But if anyone is interested in knowing more, they need to read your book Food Fight, because I think that's a great encapsulation of where we still are basically.

Well, Julie, it's nice of you to say that. You know what you reminded me one time I was on a panel and a speaker asks the audience, how many minutes do you live from a Dunkin Donuts? And people sort of thought about it and nobody was more than about five minutes from a Dunkin Donuts. And if I think about where I live in North Carolina, a typical place to live, I'm assuming in America. And boy, within about five minutes, 10 minutes from my house, there's so many fast-food places. And then if you add to that the gas stations that have foods and the drug store that has foods. Not to mention the supermarkets. It's just a remarkable environment out there. And boy, you have to have kind of iron willpower to not stop and want that food. And then once it hits your body, then all heck breaks loose. It's a crazy, crazy environment, isn't it? Kevin, talk to us, if you will, about when this food environment collides with human biology. And what happens to normal biological processes that tell us how much we should eat, when we should stop, what we should eat, and things like that.

I think that that is one of the newer pieces that we're really just getting a handle on some of the science. It's been observed for long periods of time that if you change a rat's food environment like Tony Sclafani did many, many years ago. That rats aren't trying to maintain their weight. They're not trying to do anything other than eat whatever they feel like. And, he was having a hard time getting rats to fatten up on a high fat diet. And he gave them this so-called supermarket diet or cafeteria diet composed of mainly human foods. And they gained a ton of weight. And I think that pointed to the fact that it's not that these rats lacked willpower or something like that. That they weren't making these conscious choices in the same way that we often think humans are entirely under their conscious control about what we're doing when we make our food choices. And therefore, we criticize people as having weak willpower when they're not able to choose a healthier diet in the face of the food environment. I think the newer piece that we're sort of only beginning to understand is how is it that that food environment and the foods that we eat might be changing this internal symphony of signals that's coming from our guts, from the hormones in our blood, to our brains and the understanding that of food intake. While you might have control over an individual meal and how much you eat in that individual meal is under biological control. And what are the neural systems and how do they work inside our brains in communicating with our bodies and our environment as a whole to shift the sort of balance point where body weight is being regulated. To try to better understand this really intricate interconnection or interaction between our genes, which are very different between people. And thousands of different genes contributing to determining heritability of body size in a given environment and how those genes are making us more or less susceptible to these differences in the food environment. And what's the underlying biology? I'd be lying to say if that we have that worked out. I think we're really beginning to understand that, but I hope what the book can give people is an appreciation for the complexity of those internal signals and that they exist. And that food intake isn't entirely under our control. And that we're beginning to unpack the science of how those interactions work.

It's incredibly interesting. I agree with you on that. I have a slide that I bet I've shown a thousand times in talks that I think Tony Sclafani gave me decades ago that shows laboratory rats standing in front of a pile of these supermarket foods. And people would say, well, of course you're going to get overweight if that's all you eat. But animals would eat a healthy diet if access to it. But what they did was they had the pellets of the healthy rat chow sitting right in that pile.

Exactly.

And the animals ignore that and overeat the unhealthy food. And then you have this metabolic havoc occur. So, it seems like the biology we've all inherited works pretty well if you have foods that we've inherited from the natural environment. But when things become pretty unnatural and we have all these concoctions and chemicals that comprise the modern food environment the system really breaks down, doesn't it?

Yeah. And I think that a lot of people are often swayed by the idea as well. Those foods just taste better and that might be part of it. But I think that what we've come to realize, even in our human experiments where we change people's food environments... not to the same extent that Tony Sclafani did with his rats, but for a month at a time where we ask people to not be trying to gain or lose weight. And we match certain food environments for various nutrients of concern. You know, they overeat diets that are higher in these so-called ultra-processed foods and they'd spontaneously lose weight when we remove those from the diet. And they're not saying that the foods are any more or less pleasant to eat. There's this underlying sort of the liking of foods is somewhat separate from the wanting of foods as neuroscientists are beginning to understand the different neural pathways that are involved in motivation and reward as opposed to the sort of just the hedonic liking of foods. Even the simple explanation of 'oh yeah, the rats just like the food more' that doesn't seem to be fully explaining why we have these behaviors. Why it's more complicated than a lot of people make out.

Let's talk about ultra-processed foods and boy, I've got two wonderful people to talk to about that topic. Julia, let's start with your opinion on this. So tell us about ultra-processed foods and how much of the modern diet do they occupy?

So ultra-processed foods. Obviously there's an academic definition and there's a lot of debate about defining this category of foods, including in the US by the Health and Human Services. But the way I think about it is like, these are foods that contain ingredients that you don't use in your home kitchen. They're typically cooked. Concocted in factories. And they now make up, I think it's like 60% of the calories that are consumed in America and in other similar high-income countries. And a lot of these foods are what researchers would also call hyper palatable. They're crossing these pairs of nutrient thresholds like carbohydrate, salt, sugar, fat. These pairs that don't typically exist in nature. So, for the reasons you were just discussing they seem to be particularly alluring to people. They're again just like absolutely ubiquitous and in these more developed contexts, like in the US and in the UK in particular. They've displaced a lot of what we would think of as more traditional food ways or ways that people were eating. So that's sort of how I think about them.

You know, if you go to a supermarket these days, it's pretty hard to find a part of the supermarket that doesn't have these foods. You know, whole entire aisles of processed cereals and candies and chips and soft drinks and yogurts, frozen foods, yogurts. I mean, it's just, it's all over the place. And you know, given that if the average is 60% of calories, and there are plenty of people out there who aren't eating any of that stuff at all. For the other people who are, the number is way higher. And that, of course, is of great concern. So there have been hundreds of studies now on ultra-processed foods. It was a concept born not that long ago. And there's been an explosion of science and that's all for the good, I think, on these ultra-processed foods. And perhaps of all those studies, the one discussed most is one that you did, Kevin. And because it was exquisitely controlled and it also produced pretty striking findings. Would you describe that original study you did and what you found?

Sure. So, the basic idea was one of the challenges that we have in nutrition science is accurately measuring how many calories people eat. And the best way to do that is to basically bring people into a laboratory and measure. Give them a test meal and measure how many calories they eat. Most studies of that sort last for maybe a day or two. But I always suspected that people could game the system if for a day or two, it's probably not that hard to behave the way that the researcher wants, or the subject wants to deceive the researcher. We decided that what we wanted to do was bring people into the NIH Clinical Center. Live with us for a month. And in two two-week blocks, we decided that we would present them with two different food environments essentially that both provided double the number of calories that they would require to maintain their body weight. Give them very simple instructions. Eat as much or as little as you'd like. Don't be trying to change your weight. We're not going to tell you necessarily what the study's about. We're going to measure lots of different things. And they're blinded to their weight measurements and they're wearing loose fitting scrubs and things like that, so they can't tell if their clothes are getting tighter or looser. And so, what we did is in for one two-week block, we presented people with the same number of calories, the same amount of sugar and fat and carbs and fiber. And we gave them a diet that was composed of 80% of calories coming from these ultra-processed foods. And the other case, we gave them a diet that was composed of 0% of calories from ultra-processed food and 80% of the so-called minimally processed food group. And what we then did was just measured people's leftovers essentially. And I say we, it was really the chefs and the dieticians at the clinical center who are doing all the legwork on this. But what we found was pretty striking, which was that when people were exposed to this highly ultra-processed food environment, despite being matched for these various nutrients of concern, they overate calories. Eating about 500 calories per day on average, more than the same people in the minimally processed diet condition. And they gained weight and gained body fat. And, when they were in the minimally processed diet condition, they spontaneously lost weight and lost body fat without trying in either case, right? They're just eating to the same level of hunger and fullness and overall appetite. And not reporting liking the meals any more or less in one diet versus the other. Something kind of more fundamental seemed to have been going on that we didn't fully understand at the time. What was it about these ultra-processed foods? And we were clearly getting rid of many of the things that promote their intake in the real world, which is that they're convenient, they're cheap, they're easy to obtain, they're heavily marketed. None of that was at work here. It was something really about the meals themselves that we were providing to people. And our subsequent research has been trying to figure out, okay, well what were the properties of those meals that we were giving to these folks that were composed primarily of ultra-processed foods that were driving people to consume excess calories?

You know, I've presented your study a lot when I give talks. It's nice hearing it coming from you rather than me. But a couple of things that interest me here. You use people as their own controls. Each person had two weeks of one diet and two weeks of another. That's a pretty powerful way of providing experimental control. Could you say just a little bit more about that?

Yeah, sure. So, when you design a study, you're trying to maximize the efficiency of the study to get the answers that you want with the least number of participants while still having good control and being able to design the study that's robust enough to detect a meaningful effect if it exists. One of the things that you do when you analyze studies like that or design studies like that, you could just randomize people to two different groups. But given how noisy and how different between people the measurement of food intake is we would've required hundreds of people in each group to detect an effect like the one that we discovered using the same person acting as their own control. We would still be doing the study 10 years later as opposed to what we were able to do in this particular case, which is completed in a year or so for that first study. And so, yeah, when you kind of design a study that way it's not always the case that you get that kind of improvement in statistical power. But for a measurement like food intake, it really is necessary to kind of do these sorts of crossover type studies where each person acts as their own control.

So put the 500 calorie increment in context. Using the old fashioned numbers, 3,500 calories equals a pound. That'd be about a pound a week or a lot of pounds over a year. But of course, you don't know what would happen if people were followed chronically and all that. But still 500 calories is a whopping increase, it seems to me.

It sure is. And there's no way that we would expect it to stay at that constant level for many, many weeks on end. And I think that's one of the key questions going forward is how persistent is that change. And how does something that we've known about and we discuss in our books the basic physiology of how both energy expenditure changes as people gain and lose weight, as well as how does appetite change in a given environment when they gain and lose weight? And how do those two processes eventually equate at a new sort of stable body weight in this case. Either higher or lower than when people started the program of this diet manipulation. And so, it's really hard to make those kinds of extrapolations. And that's of course, the need for further research where you have longer periods of time and you, probably have an even better control over their food environment as a result.

I was surprised when I first read your study that you were able to detect a difference in percent body fat in such a short study. Did that surprise you as well?

Certainly the study was not powered to detect body fat changes. In other words, we didn't know even if there were real body fat changes whether or not we would have the statistical capabilities to do that. We did use a method, DXA, which is probably one of the most precise and therefore, if we had a chance to measure it, we had the ability to detect it as opposed to other methods. There are other methods that are even more precise, but much more expensive. So, we thought that we had a chance to detect differences there. Other things that we use that we also didn't think that we necessarily would have a chance to detect were things like liver fat or something like that. Those have a much less of an ability. It's something that we're exploring now with our current study. But, again, it's all exploratory at that point.

So what can you tell us about your current study?

We just wrapped it up, thankfully. What we were doing was basically re-engineering two new ultra-processed diets along parameters that we think are most likely the mechanisms by which ultra-processed meals drove increased energy intake in that study. One was the non-beverage energy density. In other words, how many calories per gram of food on the plate, not counting the beverages. Something that we noticed in the first study was that ultra-processed foods, because they're essentially dried out in the processing for reasons of food safety to prevent bacterial growth and increased shelf life, they end up concentrating the foods. They're disrupting the natural food matrix. They last a lot longer, but as a result, they're a more concentrated form of calories. Despite being, by design, we chose the overall macronutrients to be the same. They weren't necessarily higher fat as we often think of as higher energy density. What we did was we designed an ultra-processed diet that was low in energy density to kind of match the minimally processed diet. And then we also varied the number of individual foods that were deemed hyper palatable according to kind of what Julia said that crossed these pairs of thresholds for fat and sugar or fat and salt or carbs and salt. What we noticed in the first study was that we presented people with more individual foods on the plate that had these hyper palatable combinations. And I wrestle with the term terminology a little bit because I don't necessarily think that they're working through the normal palatability that they necessarily like these foods anymore because again, we asked people to rate the meals and they didn't report differences. But something about those combinations, regardless of what you call them, seemed to be driving that in our exploratory analysis of the first study. We designed a diet that was high in energy density, but low in hyper palatable foods, similar to the minimally processed. And then their fourth diet is with basically low in energy density and hyper palatable foods. And so, we presented some preliminary results last year and what we were able to show is that when we reduced both energy density and the number of hyper palatable foods, but still had 80% of calories from ultra-processed foods, that people more or less ate the same number of calories now as they did when they were the same people were exposed to the minimally processed diet. In fact they lost weight, to a similar extent as the minimally processed diet. And that suggests to me that we can really understand mechanisms at least when it comes to calorie intake in these foods. And that might give regulators, policy makers, the sort of information that they need in order to target which ultra-processed foods and what context are they really problematic. It might give manufacturers if they have the desire to kind of reformulate these foods to understand which ones are more or less likely to cause over consumption. So, who knows? We'll see how people respond to that and we'll see what the final results are with the entire study group that, like I said, just finished, weeks ago.

I respond very positively to the idea of the study. The fact that if people assume ultra-processed foods are bad actors, then trying to find out what it is about them that's making the bad actors becomes really important. And you're exactly right, there's a lot of pressure on the food companies now. Some coming from public opinion, some coming from parts of the political world. Some from the scientific world. And my guess is that litigation is going to become a real actor here too. And the question is, what do you want the food industry to do differently? And your study can really help inform that question. So incredibly valuable research. I can't wait to see the final study, and I'm really delighted that you did that. Let's turn our attention for a minute to food marketing. Julia, where does food marketing fit in all this?

Julia - What I was very surprised to find while we were researching the book was this deep, long history of calls against marketing junk food in particular to kids. I think from like the 1950s, you have pediatrician groups and other public health professionals saying, stop this. And anyone who has spent any time around small children knows that it works. We covered just like a little, it was from an advocacy group in the UK that exposed aid adolescents to something called Triple Dip Chicken. And then asked them later, pick off of this menu, I think it was like 50 items, which food you want to order. And they all chose Triple Dip chicken, which is, as the name suggests, wasn't the healthiest thing to choose on the menu. I think we know obviously that it works. Companies invest a huge amount of money in marketing. It works even in ways like these subliminal ways that you can't fully appreciate to guide our food choices. Kevin raised something really interesting was that in his studies it was the foods. So, it's a tricky one because it's the food environment, but it's also the properties of the foods themselves beyond just the marketing. Kevin, how do you think about that piece? I'm curious like.

Kevin - I think that even if our first study and our second study had turned out there's no real difference between these artificial environments that we've put together where highly ultra-processed diets lead to excess calorie intake. If that doesn't happen, if it was just the same, it wouldn't rule out the fact that because these foods are so heavily marketed, because they're so ubiquitous. They're cheap and convenient. And you know, they're engineered for many people to incorporate into their day-to-day life that could still promote over consumption of calories. We just remove those aspects in our very artificial food environment. But of course, the real food environment, we're bombarded by these advertisements and the ubiquity of the food in every place that you sort of turn. And how they've displaced healthy alternatives, which is another mechanism by which they could cause harm, right? It doesn't even have to be the foods themselves that are harmful. What do they displace? Right? We only have a certain amount the marketers called stomach share, right? And so, your harm might not be necessarily the foods that you're eating, but the foods that they displaced. So even if our experimental studies about the ultra-processed meals themselves didn't show excess calorie intake, which they clearly did, there's still all these other mechanisms to explore about how they might play a part in the real world.

You know, the food industry will say that they're agnostic about what foods they sell. They just respond to demand. That seems utter nonsense to me because people don't overconsume healthy foods, but they do overconsume the unhealthy ones. And you've shown that to be the case. So, it seems to me that idea that they can just switch from this portfolio of highly processed foods to more healthy foods just doesn't work out for them financially. Do you think that's right?

I honestly don't have that same sort of knee jerk reaction. Or at least I perceive it as a knee jerk reaction, kind of attributing malice in some sense to the food industry. I think that they'd be equally happy if they could get you to buy a lot and have the same sort of profit margins, a lot of a group of foods that was just as just as cheap to produce and they could market. I think that you could kind of turn the levers in a way that that would be beneficial. I mean, setting aside for example, that diet soda beverages are probably from every randomized control trial that we've seen, they don't lead to the same amount of weight gain as the sugar sweetened alternatives. They're just as profitable to the beverage manufacturers. They sell just as many of them. Now they might have other deleterious consequences, but I don't think that it's necessarily the case that food manufacturers have to have these deleterious or unhealthy foods as their sole means of attaining profit.

Thanks for that. So, Julia, back to you. You and Kevin point out in your book some of the biggest myths about nutrition. What would you say some of them are?

I think one big, fundamental, overarching myth is this idea that the problem is in us. That this rise of diet related diseases, this explosion that we've seen is either because of a lack of willpower. Which you have some very elegant research on this that we cite in the book showing willpower did not collapse in the last 30, 40 years of this epidemic of diet related disease. But it's even broader than that. It's a slow metabolism. It's our genes. Like we put the problem on ourselves, and we don't look at the way that the environment has changed enough. And I think as individuals we don't do that. And so much of the messaging is about what you Kevin, or you Kelly, or you Julia, could be doing better. you know, do resistance training. Like that's the big thing, like if you open any social media feed, it's like, do more resistance training, eat more protein, cut out the ultra-processed foods. What about the food environment? What about the leaders that should be held accountable for helping to perpetuate these toxic food environments? I think that that's this kind of overarching, this pegging it and also the rise of personalized nutrition. This like pegging it to individual biology instead of for whatever the claim is, instead of thinking about how did environments and don't want to have as part of our lives. So that's kind of a big overarching thing that I think about.

It makes sense. So, let's end on a positive note. There's a lot of reason to be concerned about the modern food environment. Do you see a helpful way forward and what might be done about this? Julia, let's stay with you. What do you think?

I think so. We spent a lot of time researching history for this book. And a lot of things that seem impossible are suddenly possible when you have enough public demand and enough political will and pressure. There are so many instances and even in the history of food. We spend time with this character Harvey Wiley, who around the turn of the century, his research was one of the reasons we have something like the FDA protecting the food supply. That gives me a lot of hope. And we are in this moment where a lot of awareness is being raised about the toxic food environment and all these negative attributes of food that people are surrounded by. I think with enough organization and enough pressure, we can see change. And we can see this kind of flip in the food environment that I think we all want to see where healthier foods become more accessible, available, affordable, and the rest of it.

Sounds good. Kevin, what are your thoughts?

Yes, I just extend that to saying that for the first time in history, we sort of know what the population of the planet is going to be that we have to feed in the future. We're not under this sort of Malthusian threat of not being able to know where the population growth is going to go. We know it's going to be roughly 10 billion people within the next century. And we know we've got to change the way that we produce and grow food for the planet as well as for the health of people. We know we've got to make changes anyway. And we're starting from a position where per capita, we're producing more protein and calories than any other time in human history, and we're wasting more food. We actually know we're in a position of strength. We don't have to worry so acutely that we won't be able to provide enough food for everybody. It's what kind of food are we going to produce? How are we going to produce it in the way that's sustainable for both people and the planet? We have to tackle that anyway. And for the folks who had experienced the obesity epidemic or finally have drugs to help them and other kinds of interventions to help them. That absolve them from this idea that it's just a matter of weak willpower if we finally have some pharmaceutical interventions that are useful. So, I do see a path forward. Whether or not we take that is another question.

Bios

Dr. Kevin Hall is the section chief of Integrative Physiology Section in the Laboratory of Biological Modeling at the NIH National Institute of Diabetes and Digestive and Kidney Diseases. Kevin’s laboratory investigates the integrative physiology of macronutrient metabolism, body composition, energy expenditure, and control of food intake. His main goal is to better understand how the food environment affects what we eat and how what we eat affects our physiology. He performs clinical research studies as well as developing mathematical models and computer simulations to better understand physiology, integrate data, and make predictions. In recent years, he has conducted randomized clinical trials to study how diets high in ultra-processed food may cause obesity and other chronic diseases. He holds a Ph.D. from McGill University.

Julia Belluz is a Paris-based journalist and a contributing opinion writer to the New York Times, she has reported extensively on medicine, nutrition, and global public health from Canada, the US, and Europe. Previously, Julia was Vox's senior health correspondent in Washington, DC, a Knight Science Journalism fellow at the Massachusetts Institute of Technology in Cambridge, and she worked as a reporter in Toronto and London. Her writing has appeared in a range of international publications, including the BMJ, the Chicago Tribune, the Economist, the Globe and Mail, Maclean’s, the New York Times, ProPublica, and the Times of London. Her work has also had an impact, helping improve policies on maternal health and mental healthcare for first responders at the hospital- and state-level, as well as inspiring everything from scientific studies to an opera. Julia has been honored with numerous journalism awards, including the 2016 Balles Prize in Critical Thinking, the 2017 American Society of Nutrition Journalism Award, and three Canadian National Magazine Awards (in 2007 and 2013). In 2019, she was a National Academies of Sciences, Engineering, and Medicine Communications Award finalist. She contributed chapters on public health journalism in the Tactical Guide to Science Journalism, To Save Humanity: What Matters Most for a Healthy Future, and was a commissioner for the Global Commission on Evidence to Address Societal Challenges.