After a month-long delay, the Make America Healthy Again (MAHA) Commission’s strategy to address child health was released by the White House on Tuesday – but it offers few concrete proposals and no curbs on ultra-processed food or pesticides.

“We are now the sickest country in the world,” said US Health and Human Services (HHS)Secretary Robert F Kennedy Jr at the launch of the event, revealing that 76.4% of Americans are suffering from a chronic disease.

“We have the highest chronic disease burden of any country in the world. Yet we spend more on healthcare than any country in the world. We spend two to three times more than  European nations,” added Kennedy.

The strategy is the follow-up to MAHA’s first report, released in May, which laid out the commission’s assessment of the drivers of the ill-health of America’s children. 

While the MAHA strategy was intended to outline how to address these drivers, instead it presents a shopping list of 128 recommendations. that focus on conducting more research. This includes for nutrition, one of the key drivers of the US epidemics of obesity and non-communicable diseases (NCDs).

Ironically, the MAHA report was published on the eve of a global UNICEF report on childhood nutrition, which blames obesity in children on the increased consumption of ultra-processed food high in sugar, refined starch, salt, unhealthy fats and additives.

Noting that 21% of US children are obese, UNICEF proposes “mandatory policies to improve children’s food environments”, such as front-of-pack labelling on unhealthy products, restricting marketing to children, and higher taxes on unhealthy products.

In contrast, all that the MAHA strategy proposes is three nutrition-related recommendations: a standard definition of ultra-processed food, possible revisions to “front-of-pack nutrition information” after public comment and “potential industry guidelines to limit the direct marketing of certain unhealthy foods to children”.

‘Waffle words’

Marion Nestle, Emeritus Professor of Nutrition, Food Studies, and Public Health at New York University, said that the strategy “states intentions, but when it comes to policy, it has one strong, overall message: more research needed”.

Nestle, one of the world’s leading researchers on the influence of Big Food on health, was reacting to a leaked draft of the strategy in August, which has remained essentially the same as that released this week.

“Regulate?  Not a chance, except for the long overdue closure of the GRAS loophole (which lets corporations decide for themselves whether chemical additives are safe),” wrote Nestle.

“Everything else is waffle words: explore, coordinate, partner, prioritize, develop, or work toward.”

She also highlighted contradictions, such as prioritising “whole healthy foods” in nutrition assistance programs and promoting healthy meals in child care settings – while the Trump administration has cut the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), which give food support to low-income people, pregnant women, breastfeeding mothers and mothers of children under the age of five.

“It doesn’t look like this is anything more than voluntary (and we know how voluntary works with the food industry; it doesn’t).  None of this says how or has any teeth behind it,” Nestle concluded.

Pesticides: Industry has prevailed

One of the dangers that the first MAHA report identified is children’s exposure to chemicals – including “heavy metals, PFAS [“forever chemicals”], pesticides, and phthalates”.

It also highlighted that studies of the pesticide, glyphosate (marketed as Roundup), “have noted a range of possible health effects, ranging from reproductive and developmental disorders as well as cancers, liver inflammation and metabolic disturbances”, while experimental animal studies have shown that exposure to another pesticide, atrazine, “can cause endocrine disruption and birth defects”.

The US uses more than one billion pounds of pesticides annually, which linger in the soil and groundwater. A 2021 study reported that pesticides had been found in 90% of the 442 US streams sampled by federal scientists.

However, farmers’ bodies – part of Trump’s rural support base – asserted that restricting pesticides such as atrazine and glyphosate will push up their costs and reduce yields. 

Conflict over pesticides between MAHA supporters and Trump allies is likely to have delayed the release of the report.

Ultimately, lobbying by farmers and the chemical industry has worked, as the MAHA strategy makes no mention of either atrazine or glyphosate, and simply affirms support for the Environmental Protection Agency’s (EPA) process to control pesticides. 

“EPA, partnering with food and agricultural stakeholders, will work to ensure that the public has awareness and confidence in EPA’s pesticide robust review procedures and how that relates to the limiting of risk for users and the general public and informs continual improvement,” is the report’s only statement on pesticide control.

However, the EPA under Administrator Lee Zeldin has systematically removed environmental regulation over industries – from pollution controls to pesticide restrictions – since Trump assumed office.

Zeldin told Tuesday’s launch that the strategy “outlines the keys to success, from pro-growth policies that advance research to driving innovation, private sector collaboration, [and] increased public awareness”.

Moms Across America, an important part of Kennedy’s MAHA alliance, said it is 

“deeply disappointed that the committee allowed the chemical companies to influence the report”, describing the reference to the EPA improving its communication of its review process as “a pathetic attempt to assuage the American people”.

“Clearly, eliminating the words ‘glyphosate and atrazine’ (that were in the first report) is not a result of new science that shows these two most widely used herbicides to be safe, but rather a tactic to appease the pesticide companies,” the group said in a statement.

“Better words on the EPA’s website WILL NOT reduce childhood chronic illness, only bans and restrictions of pesticides will.”

Farmers are satisfied

In contrast, farmers generally expressed satisfaction with the strategy, particularly the powerful American Soybean Association, with almost half a million members who are massive consumers of glyphosate and atrazine, 

“Soybean farmers are thankful the MAHA Commission recognized EPA’s approval process as the global gold standard,” said ASA President Caleb Ragland. “Between the May report and today’s strategy, the Commission was accessible and open to learning more about modern farming practices. We truly felt like we had a seat at the table, and for that, we are incredibly appreciative.”

American Farm Bureau Federation President Zippy Duvall welcomed “a renewed focus on American-grown fresh fruits, vegetables and meat, along with reintroducing whole milk into the school meal programs”.

“Prioritizing voluntary conservation efforts for farmers and ranchers and optimizing EPA’s already robust pesticide regulatory process to accelerate innovation are welcome recommendations,” added  Duvall.

Vaccine pronouncements

The strategy also promises to “ensure that America has the best childhood vaccine schedule” by “addressing vaccine injuries, modernising vaccines with transparent, gold standard science, correcting conflicts of interest and misaligned incentives” and “ensuring scientific and medical freedom”.

The American Academy of Pediatrics, which has clashed with Kennedy over changes in access to COVID-19 vaccines, said that it “cannot ignore the fact that this report is being published in the context of other recent harmful actions by the administration and Congress that undermine many of the report’s recommendations”. 

“This administration’s unprecedented cuts to Medicaid and SNAP, along with its chaotic, confusing actions restricting vaccine access are worsening – not resolving—efforts to improve children’s health,” noted AAP, which represented 67,000 paediatricians.

Professor Peter Hotez, co-director of the Texas Children’s Hospital Center for Vaccine Development, described the strategy as “more of the same wellness/influencer grift and pseudoscience that antivaccine activists have been pushing for years”.

Hotez, who is also Dean of the National School of Tropical Medicine at Baylor University, added that “medical freedom” is a “propaganda term that accelerated in the 2010s to deny kids access to life-saving vaccines, as announced in Florida last week”.

Action on medicines

The strategy has proposed a working group on prescriptions for medicines including selective serotonin reuptake inhibitors, antipsychotics and mood stabilisers.

Late Tuesday, President Donald Trump issued a presidential memorandum to ensure that “direct-to-consumer prescription drug advertisements are providing consumers with full and accurate information”.

The memorandum directs Kennedy to ensure that prescription drug advertisements increase the amount of information regarding any risks associated with the use of prescription drugs.