America, August 2016Carlo Allegri / Reuters

Last week The New York Times reported, “Donald Trump Checkup Said to Reveal He Is Overweight.”

This revelation was a prelude to the Republican candidate's appearance on The Dr. Oz Show on Thursday. There Trump appeared surprised by one question about obesity. The question was not about Trump’s own body mass, but rather what he planned to do about the metabolic health of American children.

It was a sobering moment, a reminder that concerns about Donald Trump or Hillary Clinton’s health should be dwarfed by concerns about how the candidates would affect everyone else’s health. The fundamental way that will happen is by affecting the leading cause of poor health in the country: the food we eat. On that topic the two candidates could not be more different.

Trump’s explanation of obesity on Oz’s show was barely coherent and extremely consequential. I’ll get to that, but to set the scene: Until that point, the best part of the interview was a canned exchange in which Trump revealed that he possessed—in his jacket pocket—a crisp copy of a new doctor’s note, from none other than the irascible Harold Bornstein. Oz asked if he could maybe see the letter. Trump said yes. The premise was like a skit on Sesame Street. What followed was a bizarre review of some basic blood tests and Oz emphasizing that he is not Trump’s doctor while performing a simulation of a patient-doctor interaction, reading off numbers like the weight of the candidate’s body, and his cholesterol levels, and asking questions like, “Any bladder or prostate issues?” (Only near the end of the hour-long program did Oz ask, “May I ask a personal question?”)

The personal question was about Trump’s brother’s substance addiction. How did Trump learn and grow from it? Throughout the hour, Oz gave the candidate free rein to explain that he is healthy, vigorous, passionate, patriotic, and compassionate. Oz then nodded and moved to the next question. For example, “Why do you think you have the stamina for the job?”

This was all in contrast to what happened when Oz let his audience ask questions of Trump, at the very end. Oz only made time for two. The first was important:

Audience member: Hi. Mr. Trump, I am a teacher and I see obesity every day. How would you go about handling the obesity problem in the country—especially among children—and the fact that many schools are not providing enough exercise in recess time?

Trump: That is a school thing to a certain extent. I guess you could say it’s a hereditary thing, too. I would imagine it certainly is a hereditary thing. But a lot of schools aren’t providing proper food because they have budget problems, and they’re buying cheaper food and not as good of food. And the big thing—when I went to school I always loved sports, and I would always—I loved to eat and I loved sports, and it worked, because I could do both. A lot of schools today, they don't have sports programs, and that is a big problem. I would try and open that up. I’m a big believer in the whole world of sports. I would try and open that up.

Where to begin.

Unlike his other responses, this one did sound wholly unrehearsed. The teacher in the audience was reading the question from a card, but the question may not have been known to Trump in advance. It’s less likely that he is suggesting genetic modification of children than simply doing the stream-of-consciousness speculation for which he has become known and, in some circles, adored.

That might be adorable in another time and place, on another topic, from a person who is not presuming himself qualified to lead the country. Right now, though, half of Americans are overweight and a third are obese. We spend $322 billion every year treating diabetes and pre-diabetes alone, conditions that are typically due to (and always exacerbated by) poor diet.

This is not to mention the leading cause of death, cardiovascular disease, which is also often largely caused and prevented by the food we eat. To ward off and control these conditions, we are told to eat a diet that is primarily fruits and vegetables (and nuts, seeds, and legumes), preferably in minimally processed forms.

This is a long-standing consensus, from experts inside and outside of the government. And yet our system is incentivized to produce highly processed foods and animal products. The federal government subsidizes corn and soy production in order to feed factory-farmed, antibiotic-engorged animals but leaves fruit and vegetable production to fend for itself. This system is not fixed by giving money to schools.

Trump also appears to be misinformed about the role of exercise. Which is important to health in holistic ways. For example, one study found the effect of regular physical activity to be comparable to ADHD medication in kids. Exercise helps to prevent cardiac and cerebral vascular disease. It staves off depression. Essentially our bodies malfunction when unused.

But seeing exercise as a tool to balance a calorie scale is misguided. Moving cannot mitigate the health effects of eating poorly. That is a pernicious myth that has left many people sick. Even as a measure of burning and balancing calories—a dangerously reductive way to think about the health effects of food—burning excess energy is far more time consuming and less feasible than eating less. As Sara Bleich at Johns Hopkins School of Public Health reminds us, a single bottle of Coke would require the average person to jog for 50 minutes.

This is all to reiterate that obesity is primarily a problem of the food system, and this is the answer any candidate needs to give to a question like the teacher’s—immediately and without reservation. Because the problem is far-reaching and complex, and our future demands that these issues be confronted. From agricultural subsidies to direct-to-child marketing to poor access to whole plant foods, this system is the fundamental cause of the epidemic. The spread of metabolic derangement (obesity often accompanied by diabetes and hypertension) is at the core of the leading causes of death and infirmity in the United States, where these issues drive health-care costs that are destabilizing the national economy. All of this comes back to food.

While the topic could warrant its own presidential debate, neither candidate has made an explicit priority of fundamentally reforming our food system. Hillary Clinton has called for emergency action on climate change, and animal agriculture is a more consequential and actionable source of greenhouse-gas emissions than are automobiles. Clinton’s stated climate priorities do not mention agriculture, but the Democratic Party Platform does briefly mention “promoting environmentally sustainable agricultural policies.”

Journalist Tom Philpott at Mother Jones explains that Clinton’s strongest stance on food may be her promise to develop antitrust laws to “protect competition and prevent excessively consolidated economic and political power”—the first mention of antitrust policy in the party’s presidential platform in decades. “If a President Clinton were to make good on it,” Philpott writes, “there could be profound implications for our highly concentrated food industry.”

Trump has indicated, to the contrary, that he would further entrench the federal government in the current, unsustainable agricultural system. He has taken as his advisors the Iowa hog mogul Bruce Rastetter and the president of the Texas Oil and Gas Association Todd Staples, who resigned as the state’s agriculture commissioner in 2014 because he was “very concerned” that a northwestern Texas school district was implementing Meatless Mondays. Staples called the idea “treasonous.”

Perpetuating the current system is a myopic approach that threatens global health not just by environmental impact and loss of biodiversity, but by way of antibiotic resistance arising on factory farms. Using land to cultivate animals is also a less efficient use of space, water, and energy than growing plants. This means more people go hungry.

To that end, Clinton has indicated that she would protect  the Supplemental Nutrition Assistance Program (SNAP), which provides grocery vouchers. The party platform describes SNAP as “our nation’s most important anti-hunger program.” Nearly half of people in the program are children, and many others are elderly or disabled. Republicans have repeatedly attempted to eliminate or scale back the program, though enrollment has organically fallen in recent years. As the economy has improved, the number of Americans receiving nutritional assistance is at its lowest rate since October of 2010.

The current Republican platform recommends breaking the SNAP program away from the farm bill, which would make it susceptible to budgetary cuts. In a similar vein, on Thursday Trump’s campaign website posted a policy statement that promised to eliminate several environmental-protection programs, as well as something called “the FDA Food Police,” an entity that does not exist but appeared to be an allusion to paring down rules regulating “farm and food-production hygiene, food packaging, food temperatures, and even what animals may roam which fields and when,” suggesting that taxes to pay for these regulations is “overkill.”

The Trump campaign then removed the posting without explanation. The candidate’s positions on these subjects remain unclear. What I gleaned from that glimpse was that they will involve a surface-level deregulation of the industry while maintaining deep-seated government support.

For those who truly oppose government intervention in the food system, like Bard College researcher Gidon Eshel, an alternative to this untenable system is clear: “Remove the artificial support given to the livestock industry and rising prices will do the rest.”

Neither candidate has expressed a clear plan to create a sustainable food system that promotes health, but Clinton at least has an outline.

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