Über Gewicht – Gespräch mit Prof. Dr. Marion Nestle (englisch)

(Dieses Transkript wurde automatisiert erstellt.)

DR. LAURA WEISENBURGER Wie angekündigt könnt ihr diese Woche alle Interviews in voller Länge nachhören zu unserem Spezial Thema Adipositas in unserem Spezialmonat August, in dem wir uns immer noch befinden.

Mein Kollege Dennis Ballwieser hat auch mit Professorin Marion Nestle gesprochen und sie haben sich dafür in New York getroffen, wo sie lebt und arbeitet. Ihr erinnert euch vielleicht, sie hat im Podcast sehr viel über Werbung und Marketing gesprochen, insbesondere, was das für einen Einfluss auf die Kinder haben kann. Das Gespräch ist wieder klar auf Englisch wenn ihr wollt, könnt ihr es auf Deutsch nachlesen. Da haben wir nämlich einen Artikel auf ApothekenUmschau.de und den verlinken wir euch in Shownotes.

SPRECHER ‘ne Dosis Wissen – der Podcast für Health Professionals.

DR. LAURA WEISENBURGER Und damit guten Morgen und willkommen bei ‘ne Dosis Wissen. Schön, dass ihr wieder dabei seid. Heute ist Dienstag, der 26. August 2025 und mein Name ist Laura Weisenburger. Ich wünsche euch viel Spaß beim Gespräch!

SPRECHER Ein Podcast von gesundheit-hören und Apotheken Umschau Pro.

(Interview)

DR. DENNIS BALLWIESER I'm sitting down with Prof. Marion Nestle at New York University in New York City and thank you for having us. My pleasure. Professor Nestle, when you grew up as a kid, what was your comfort food that you think of that you might smell or taste still now?

PROF. MARION NESTLE Well, I've always loved ice cream. Ice cream? Then and now.

DR. DENNIS BALLWIESER And how was food at your home when you grew up? How was food prepared? Which kinds of food were your parents?

PROF. MARION NESTLE Well, I grew up during the Second World War, and food was very scarce. It was rationed, and I don't remember it tasting very good. It was, you know, we had canned vegetables. There wasn't much fresh food. I was in New York City as a young child. And I really didn't like, you didn't think about it. It didn't taste very good, it wasn't very interesting, and it was just food

DR. DENNIS BALLWIESER So this was still time when calories did count, getting children the calories that they needed to grow up, right?

PROF. MARION NESTLE Well, yes, people were very concerned about making sure the children ate their vegetables. I do remember during the war being given small glasses of orange juice with these fish supplement things, cod liver oil as vitamins, because there were no supplements and parents were worried about getting vitamins into their kids.

DR. DENNIS BALLWIESER How do you feel going down a supermarket aisle nowadays. Nowadays? The abundance of food and calories.

PROF. MARION NESTLE Well, I do research on supermarkets, so it's where I do my research. It's the first thing I do when I go to a new city anywhere in the world, is head for the closest supermarket.

DR. DENNIS BALLWIESER are you able to turn your head off when you go shopping for yourself for your own cooking at home?

PROF. MARION NESTLE Oh no, I mean I'm always looking at labels and doing things that most consumers don't bother to do.

DR. DENNIS BALLWIESER So I guess I don't have to ask if you're able to snack without thinking about food and nutrition.

PROF. MARION NESTLE Oh, yes, no, I certainly do. I mean, by this time, I eat pretty comfortably. I don't worry about food. I love food. I eat what I like. I just try not to eat too much.

DR. DENNIS BALLWIESER That brings me to my next question concerning me, because obviously I'm a heavily overweight year old male. What can I do to not get into the traps of the food companies that try to sell me more calories than I need in the supermarket?

PROF. MARION NESTLE Well, you have to do just that. You have to be aware that food is available everywhere, certainly in the United States, in very large amounts. And that the larger the portion, the greater the number of calories. And if you want to lose weight, you have to eat less. Unfortunately, that's very difficult to do. And if your trying to eat less in today's food environment, you are fighting a two trillion dollar industry all by yourself. That's hard to do!

DR. DENNIS BALLWIESER You did a lot of research on what the food industry does to make us eat more without even recognizing that we are being guided to buy more and eat more. A lot has changed in the last years, but since you published the first big book of your many books on the topic, what has improved since you wrote Food Politics?

PROF. MARION NESTLE Well, I can only speak for the United States, and it's possible to eat healthfully in any supermarket in America if you make the right choices, but the entire food system is set up for you to make the most profitable choices, not the ones that are best for your health. And it's not that food companies. Are trying to make people put on weight. Food companies are just trying to sell products. That's all they're doing.

DR. DENNIS BALLWIESER What does that mean concerning what actually is in the food nowadays compared to when it was in another time, another game for food companies?

PROF. MARION NESTLE Well, that was a long time ago, and after the Second World War, when companies had learned how to manufacture foods that could be sent to soldiers overseas and would last a long time and still be okay to eat, they then began to produce all of these, what are now called ultra-processed products, that have a very long shelf life. Are absolutely delicious. They're formulated to be so irresistible that you can't stop eating them. And you want to eat them over and over and over again because the most profitable fruit products are the ones that people eat a lot of and buy all the time.

DR. DENNIS BALLWIESER That usually means that they are high in sugar, right?

PROF. MARION NESTLE Well they're high in sugar, they're high in salt, they are high in fat. It depends on what kind of food they are. They're high on calories. They're usually extremely easy to eat. They go down very, very easily. They're digested quickly. They're not particularly satisfying, so you keep wanting more of them. You can't stop eating them. There's an old advertisement from some years ago of someone holding up a potato chip. And say, you can't eat just one. That's the whole point.

DR. DENNIS BALLWIESER And what I recognized going down the supermarket aisles in American supermarkets, it is really cheap compared to fresh foods.

PROF. MARION NESTLE Oh yes, yes.

DR. DENNIS BALLWIESER How does it come? Because they are highly processed, they come out of factories, while the other stuff simply comes out of the soil.

PROF. MARION NESTLE Well, it comes out of the soil, but it has to be taken care of. It has to kept cold. It has be kept clean. It has been taken care off. And it's perishable. Perishable foods are more expensive relatively than the not perishable ones. And the price of all foods in the United States has gone up quite a lot in the last five to ten years, particularly since the pandemic. But the price of fresh foods has gone up much much more than the price packaged foods. Because the companies that make packaged foods can buy the ingredients when they're very inexpensive Make the products put it on a shelf and leave it on the shelf.

DR. DENNIS BALLWIESER You spent a lot of thought about what at least the American politics should do in order to make it easier for the Americans to eat healthier. Did any of that come into effect in the last decades?

PROF. MARION NESTLE Oh, not really, because the basic structural issues have changed. The food companies still have to sell more product in order to satisfy their stockholders, and they do that by putting food everywhere, by creating a social environment that makes it socially acceptable to eat walking down the street or anyplace, and to eat in very large portions. And if I had one explanation for why people in America gained so much weight between 1980 and 2000 It's the portion sizes got bigger.

DR. DENNIS BALLWIESER Do you see anywhere in the world other countries that are leading by example that you would like the United States to copy?

PROF. MARION NESTLE Well, we always look to Europe for more sensible eating practices where people still eat meals and where walking down the street eating food is not socially acceptable and where snacking is not as socially acceptable, and people in those countries are leaner than we are.

DR. DENNIS BALLWIESER What do you think about taxes on sugar, for example, or stuff like that?

Well, they'd have to be high enough to make a difference.

They tried it in the United Kingdom, and it seemed to work for a small part, at least, there.

PROF. MARION NESTLE Well, I worked in the United Kingdom for a while and then they stopped it. So when they stopped, everybody went back to the way it was before.

DR. DENNIS BALLWIESER Okay, I get that it is hard to change the whole environment, but at least you have to start at some places. You wrote a lot about what the advertisement industry is allowed to put on labels advertising for foods. Why is it so important to regulate what advertisement for food does?

PROF. MARION NESTLE Well, there are two reasons. One is that if advertising is misinforming the public about the quality of the food, what's in the food what the food is likely to do, then that's misleading. And there are two ways of approaching this. One is through personal responsibility and personal choice. When you go to a supermarket and buy a food, you are making a decision about the kind of food you want to eat and the kind a food system that you want. So that's fine, but you only have a choice of what's there. And you are make that choice in the context of everything that's around there. So that, for example, companies pay slotting fees in supermarkets.

DR. DENNIS BALLWIESER What does that mean?

PROF. MARION NESTLE Well, I'm going to explain. They pay slotting feeds in super markets to place their products where they are most visible. Because the rule is, the more you see a product, the more you're likely to buy it. So that's why sugar sweetened beverages... Are in ten different places in a supermarket, because then you'll see them ten times. And if you didn't buy them the first time, maybe by the tenth time, you'll say, oh, I guess I better get this.

PROF. MARION NESTLE That's how marketing works.

DR. DENNIS BALLWIESER I know that there is some literature out there that actually asks the question if we have a free will when we are choosing what we are eating, because the environment makes it so hard for us to choose healthy foods, natural foods.

PROF. MARION NESTLE Well, yes, because what we want, I mean, we are hard-wired, I think, as humans, to love foods that have lots and lots of calories in a very small quantity of food. We evolved under conditions of great starvation and deprivation. We grew up as hunter-gatherers.

PROF. MARION NESTLE But that didn't mean hunting and gathering at a supermarket. It didn't mean that. It meant really going out and working hard to kill animals or to pick vegetables or whatever. And so we're faced with a evolutionary situation that we never had to confront at any time except in the last century.

DR. DENNIS BALLWIESER Is there like a three tip list that you would give to people like me whenever they have to go to a supermarket? Because this seems like a very hostile environment for me to be in.

PROF. MARION NESTLE Well, it's an environment that's designed to get you to buy as much food as you possibly can. That's the purpose. The purpose of a supermarket is to sell food, to sell as much to as many people as often as it possibly can, as at higher prices it can get away with. That's purpose. That's business model. So if you, the minute you walk into a supermarket, you're confronting a business model that is engineered to make you walk through as much of the store as you possibly can. That's why, in the United States at least, the milk is always as far away from the door as it possibly can be. Because that makes you walk through the aisles. That's another rule. The more products you see, the more products that you will buy. So the objective is to get you to look at as many products as possible and to see products that are most profitable. As often as possible in the store. So that's what you're up against. So if you know that, when you walk into a store, at least you have some sort of consciousness. Ah, that's there. Hmm, I want that. Why is that there? They're trying to sell that to me. Do I really need it? No, don't buy it. That's hard.

DR. DENNIS BALLWIESER I know from experience that it is hard, it makes offerings like delivering food to your home door a lot more attractive if I think about it.

PROF. MARION NESTLE Yes, except that the online delivery services put the products that are most profitable where you can most quickly see them online.

DR. DENNIS BALLWIESER On the website. So it's the same game on the internet as well.

PROF. MARION NESTLE It's exactly the same. I mean, there are many advantages to buying foods online. The fees are not one of them. But there are advantages that it gets delivered and you don't have to do all that. On the other hand, walking through the store is probably good for your exercise regime.

DR. DENNIS BALLWIESER So if I think about it and I think, okay, I will have to buy food that comes from big corporations my whole life, and I won't be able to go to the farmers market every week since I have to work as well, might there be any chance to get those huge companies to do produced food or processed food that is actually healthy for us?

PROF. MARION NESTLE Only if people will buy it.

DR. DENNIS BALLWIESER What is hindering us from buying it.

PROF. MARION NESTLE I mean, the companies are in the business of selling products. They design those products to be extremely attractive, and they do a phenomenal amount of research with people. They do focus group testing and all kinds of research, with people wearing cameras and devices and all kind of things, to find out what it is that customers want. Not necessarily what they say they want, but what they act on, what they want. And they know more about consumer buying habits than I do, or probably than you do. They're really good at what they do. Their research is extremely sophisticated, particularly their research on kids. Really, really sophisticated. And so they can predict when people go into a store what they're likely to buy. How much they're likely to buy, and where they should place the products, what kind of music they should have, what lighting they should have, where the aisles should be placed in the supermarket in order to attract the most traffic through it. All of that is research. None of it is random.

DR. DENNIS BALLWIESER Why is it so important to get to kids with that research?

PROF. MARION NESTLE Well, that, of course, now we're getting into ethical issues. It's important to get to kids because if you convince a child that a particular product is what they most like to eat, that child will want that product throughout life and will be a recurrent customer. Kids don't have any money, so they can't buy their own products, but they certainly can pester their parents for the products, and if you have small children, you know exactly what I'm talking about.

DR. DENNIS BALLWIESER I do!

PROF. MARION NESTLE Exactly. And this is called, it has a business term, it's called the pester factor. And what you want to do is you want create the pestor factor so that the kids ask you to buy particular products. And I have friends who have, I don't have young children anymore, but I have friends that have young kids who tell me they never bring fast food into the house. They have never taken their child to a McDonald's restaurant, but when they drive down the street and their child sees a McDonalds, the child will say, take me there. That's fabulous marketing. This is marketing that is so sophisticated that the parents have no idea how their children learned about this. And this is true of products as well. So, the companies put cartoons on packages, that's an indication to a child that that food is for them, it's being created specifically for them. There are games on the back of cereal boxes. Kids know these things, and those products are placed low enough so that if a child is in the store, that is what the child sees. And I don't know very many parents who want to argue with their children about food. There are so many things to argue about. You don't want to create a scene in the supermarket. But if you've ever seen a child having a tantrum in the market, and I have seen them many times, including with my own, back in the day. You don't want to fight that so the kid says I want that you put it in the cart

DR. DENNIS BALLWIESER What did you do to protect your children from all those advertisements and packages?

PROF. MARION NESTLE Well, my children were raised, they're old enough so that they weren't confronted with the level of advertising that there is now. And they were certainly not confronted with what's on social media. Social media has changed everything. I mean, really has made it impossible to control this. So things were still under control. And I do remember having... Discussions with my children about certain breakfast cereals and saying no, I'm not going to buy that one and them begging and then giving up once in a while because I don't like to, didn't want to fight with my kids about it and what difference does it make anyway.

DR. DENNIS BALLWIESER Okay, so I understand that it might be politically not feasible to intervene into advertisements for adults because they have a free choice, whatever they want to buy. But shouldn't politics be able to regulate what food companies are allowed to advertise to children?

PROF. MARION NESTLE Well, again, I can only speak to the United States. Inthe Federal Trade Commission, which regulates advertising, attempted to regulate the amount of advertising that food companies could do on television directed to children. And it was only television. It was only TV directed to children, And it was only products that were high in sugar. And the head of the Federal Trade Commission was fired. The pushback was so intense that the head of the federal trade commission was fired, Congress passed a law saying that you could not have any regulations that regulated advertising to children on television. And that was the end of that for many, many, many years, and now there's talk about it again under the new administration. There's some discussion of trying to help children be healthier, and that scandal, that enormous political uproar, was long before children were as heavy as they are now. That was before obesity became a problem for children. Since then, children have been gaining weight at an extraordinary rate, and there's a lot of concern about it. But any attempt to control marketing to children comes up against food industry interests. And they're not very happy about the idea and oppose it in every way they can. They go straight to Congress and get Congress to interfere. If there's any attempt to try to market it. They use the First Amendment, freedom of speech, as a, you know, we're advertisers, advertising is a form of speech. We're free to say whatever we want to.

DR. DENNIS BALLWIESER We look at how the recommendations on what Americans should eat or should not eat evolved over the decades. You put a lot of work into the recommendations itself in another role in the s when you worked for the administration and you wrote a lot about the food pyramid and what came after that. And, as you wrote it, it always comes down to giving advice to eat less, which is not politically feasible to do as well. Do you see any evolution in this discussion at all?

PROF. MARION NESTLE Not really, because dietary guidelines in the United States have been exactly the same for years. You know, inthey said, eat more fruits and vegetables and whole grains, don't eat too much junk food, balance calories. They still say the same thing. What they will say this year, we don't know, because we have a new administration that has pledged to disrupt all of that. But we have no idea what that means yet.

DR. DENNIS BALLWIESER If you could wish for something that the new administration, in terms of food advice or regulation on advertisements, which would be the first thing?

PROF. MARION NESTLE Oh, I would stop marketing junk food to children, just stop it immediately, and stop it in every place in which it currently exists, which means on television, on radio, on social media, particularly on social media. And I don't see any signs of any interest in even looking at any of that.

PROF. MARION NESTLE But that would be the first place I would start. Now, I know that that is marketing to children for the food industry is their line in the sand. That's where they draw the line. And I have heard food industry executives say, we would love to stop marketing to children. We think it's ethically wrong. But? But our stockholders won't let us.

DR. DENNIS BALLWIESER Wouldn't that vanish once it's a law issue, if nobody is able to do it, then it's the same set of rules for every company?

PROF. MARION NESTLE Yes, that would help a great deal. Whether the new administration will be able to do that or not, I don't know. I don't see any signs of it yet, but it's early yet.

DR. DENNIS BALLWIESER In your personal opinion, why isn't there an uproar in society? Because people are, they are usually most heavily obese people I know, me myself included, are devastated by this epidemic and would love politics to do something. Why isn't it a political issue?

PROF. MARION NESTLE Oh, because the industry is so opposed to doing anything about it. Eating less is very, very bad for business.

DR. DENNIS BALLWIESER And we as voters, we in Germany, you in the United States, why aren't we more upset about this topic? What is your thought?

PROF. MARION NESTLE Because people think if they're overweight, it's their fault. I mean, it is very, very, you know, you're told that all your life. And to change that, to say, wait a minute. I'm in a situation in which it's just impossible for me to make healthful choices because this is here and this is here, and this here. Everybody looks at you and says, what's wrong with you? Why don't you have personal responsibility? Why don't you have willpower? It's your fault. And the, you know, I look, it's very hard for people to look at these things from what in public health terms we call upstream.

PROF. MARION NESTLE And look at the forces in society that are set up to do everything they possibly can to get you personally to eat as much as you possibly can, as often as you possibly can in as large portions as you possible can consume. The whole system is set up do that. And you as an individual trying to survive in that situation are up against very powerful, often subliminal forces that we don't even see them that are trying to get you to eat more all the time.

DR. DENNIS BALLWIESER I know that my whole life I have been taught by society that it is my fault that I'm overweight. I'm not doing enough. I'm working out enough. I don't know if workout does that much to it. We can talk about that. I'm eating the wrong things and too much of it and it's my fault. How is it possibly society's fault and the medical establishment's fault that this idea is still in the heads of people like me?

PROF. MARION NESTLE You know, well, because it's so hard to understand that the supermarket is set up to get you to buy more food, not less. When you go to a restaurant, the food is delicious and they're giving you ridiculously large amounts. It's right in front of you. You're supposed to eat it.

DR. DENNIS BALLWIESER To be taught to eat all that is on your plate?

PROF. MARION NESTLE You're supposed to eat everything on your plate. It's very difficult in that situation, especially if you're with other people around who are all enjoying what they're eating, to fight an entire food system on your own. I think it's very, it's impossible for an individual to fight that. So for that you want government regulation. You need some help.

PROF. MARION NESTLE Let's let the government help, let's let the government create a level playing field for all food businesses so that everybody's up against the same kind of regulations and stop the marketing to kids. Put some controls on the size of portions. Put some control on advertising. Make supermarkets, put the healthier foods where they can be most easily seen, and where they do something about the pricing so that healthy foods are cheaper than unhealthy foods. I mean, these are policy decisions that are quite possible if the industry weren't so totally opposed to them.

DR. DENNIS BALLWIESER What do you say to people who say I don't want to live in a nanny state like that.

PROF. MARION NESTLE Well, we're already living in a nanny's state.

DR. DENNIS BALLWIESER In terms of other things that I want to say.

PROF. MARION NESTLE In terms of other things, I mean, so it's a question of which aspects of nanny state you want and, you know, nobody is stopping individuals from making choices. What you want to do is you want make the healthy choice the easy choice and the less expensive choice the most accessible choice. And that requires a changing of the food environment that's very difficult to contemplate, but it's certainly possible to do if there were a political will to do it. And we haven't said anything about the GLP- drugs yet.

DR. DENNIS BALLWIESER I'm coming to that now, because I want to spend a little time on the medical issue of obesity. Do you consider obesity to be an illness on its own? An entity on its?

PROF. MARION NESTLE Oh, I don't know. That's an argument that everybody is having. I don t think it makes any difference, really. The main reason for calling it a disease is to be able to get reimbursement from the way our healthcare system works, and I'm in favor of reimbursement. And also because the medical establishment has always treated obesity as if it were matter of personal responsibility.

DR. DENNIS BALLWIESER It's my choice to be fat.

PROF. MARION NESTLE Yeah, it's your choice. You have made that choice your fault, you take care of it without any sense of how difficult taking care of might be. Much easier to prevent than to deal with it afterwards and I'm very curious and interested in why americans started eating so much more. We have lots of evidence for that. What's your thought on it? That Americans started eating a lot more between andwhich was when the very sharp rise in obesity prevalence took place.

DR. DENNIS BALLWIESER What do you think is the main reason?

PROF. MARION NESTLE Well, there were more calories in the food supply and the food industry had to sell them. Number one, food production had increased dramatically so that the number of calories available per capita in the supply went fromfrom a day for every man, woman and child in the country toby

DR. DENNIS BALLWIESER So it had to be put into food.

PROF. MARION NESTLE Well food companies had to sell that. There it was. And all of a sudden the food supply became very competitive. It was always competitive, but now it was really competitive. So companies had to look for ways to compete. And they did that by putting food absolutely everywhere, bookstores.

DR. DENNIS BALLWIESER So that's why food is everywhere and why portion sizes got bigger.

PROF. MARION NESTLE They put food everywhere, bookstores, libraries, clothing stores, created a situation in which snacking was what you were supposed to do, so snacking to replace meals. Another rule, the more times a day you eat, the calories you take in. Sorry about that. They made food in larger portions because there was so much food available it was So you could make very large portions, which everybody loves. Everybody just loves them. The problem is larger portions have more calories. And if I had one concept to get across, it's that larger portions had more calories, it's not intuitively obvious.

DR. DENNIS BALLWIESER We are getting into calories. There are people out there who are saying a calorie is not a calorie and it depends a lot on which kind of calories you are choosing.

PROF. MARION NESTLE Yeah, wouldn't that be nice?

DR. DENNIS BALLWIESER Is that something you subscribe to too?

PROF. MARION NESTLE Well, no, we have laws of thermodynamics that govern body weight, and yes, it's easier to gain weight if you're eating a lot of junk food, ultra-processed junk food is much easier because the calories are concentrated. It's pretty hard to gain a lot weight if your eating salads.

PROF. MARION NESTLE You know, I'm not interested in eating salad. When you're eating a salad, you know when you've had enough salad. When you are eating cookies or chips or snack foods or highly ultra-processed foods, you could just keep on and on and and on. So the companies know that. That's why they make those products. But there was one other reason, and it's important to think about that, that in in the United States. Jack Welch, who was then head of General Electric, made a speech in which he kicked off the shareholder value movement. And his speech said, the only purpose of a corporation, and this was an old idea from the s, the purpose of the corporation was to make money for stockholders. And if corporations were doing anything that did not make money stockholders, they were wasting their time. Were offending their stockholders' rights and should stop right away. And this was devastating for lots of corporations. We can see the results in Boeing aircraft. This is probably the most obvious example right now. For food companies, it was devastating, because food companies were already trying to sell products in an environment in which there wascalories a day. For every man, woman, and little tiny baby in the country, roughly twice average need. And now, they not only had to make a profit, but they had to grow their profits every days and report growth to Wall Street. That's not so easy to do. People can only eat so much. You know, even if people are overeating, they can only need so much, so companies had to sell more of their product. Either get people to buy their product instead of somebody else's, eat more in general. That's what they did. They got people to eat more, in general, and that's what happened.

DR. DENNIS BALLWIESER So if society and politics both are unable to get rid of that shareholder value of the food companies, might the shareholder values of the pharmaceutical companies who are producing GLP- veganists be on the side of us overweight? Could that help?

PROF. MARION NESTLE No, because they have an enormous advantage if people are overweight. They get to sell these drugs, and these drugs are very expensive.

DR. DENNIS BALLWIESER So what I'm talking about for our viewers and listeners, of course, is that there are new medications out there for a few years now, which for the first time are able to get rid of at least a few pounds or kilograms much faster and probably more sustainable than in the last decade.

PROF. MARION NESTLE Oh, I mean these are considered miracle drugs because they not only reduce weight but they're now associated with reduction in type diabetes risk, heart disease risk, the number of illnesses that they seem to damp down is getting larger and larger and more and more people are taking them. And there's lots and lots of research about how well they're working, but certainly people are losing weight on them and don't seem to mind the side effects, which floors me because the side effects are really not very nice. And we don't know how this is gonna play out yet. Because the widespread use of them is so new that the researchers are just beginning to come out with the research. And in the United States, these drugs are extremely expensive. So they can't reach people who aren't able to afford them.

DR. DENNIS BALLWIESER So it doesn't sound like an answer to all the questions that we have around obesity and how to help people.

PROF. MARION NESTLE Yeah, the drugs don't help with prevention. What you really want is prevention.

DR. DENNIS BALLWIESER And prevention brings us back to smaller children especially.

PROF. MARION NESTLE Yes, it brings us back to children who are playing during most of the day instead of on their phones. That's a new trend in society that's changed things a lot. When my kids were young, it was long enough ago that they were gone. They were gone during the day. They were out playing. It was hard to get them back into the house for dinner.

DR. DENNIS BALLWIESER And we're talking about New York City, right?

PROF. MARION NESTLE Well, and then it was California, but yeah, I was living in California then. But no, the same thing is true in New York City. When I was a kid in New york city, I had the run of the city from a very young age. And subways were cheap, they only cost a nickel, five cents. You could go on a subway anywhere. Go to some gorgeous park and go out and play. I mean, really, we didn't have phones.

DR. DENNIS BALLWIESER That sounds a lot like the stuff that I read about how we should redesign our cities and actually the way that we travel through our cities by foot, by bike instead of car, get public transportation to work. But those are very long shots, right? If you make a political decision to change something like that, it takes almost decades until that comes into effect.

PROF. MARION NESTLE Well, you know, I live in New York City. I haven't had a car in probably years. And if you're in a place that requires a car to go anywhere, it's going to be much harder for you to prevent weight gain. I mean, these are complicated social problems that have to do with entire societies. And as an individual trying to thread your way through that, It's really tough.

DR. DENNIS BALLWIESER I want to come to one other point that bothers me personally a lot, and that is stigmatization of people who are obese. One should think if the majority of the Americans as well as the majority of the Germans is actually overweight, the majority shouldn't have any problem with being overweight, right?

PROF. MARION NESTLE In the United States, seventyfive % of adults are either overweight or obese. And % of the adults are considered obese. And I think we're up to twenty %.

DR. DENNIS BALLWIESER So why is it then that people who are obese still feel that much stigma and shame about how they...

PROF. MARION NESTLE Because they grew up at a time when there was a great deal of stigma and shame and there's still plenty of stigmatization going on.

DR. DENNIS BALLWIESER What do you think would help those people to not feel like that because I think it makes it very hard to take care of oneself if you feel stigma and shame on top of it and one thing that you might do then is eat because it gives you comfort.

PROF. MARION NESTLE Yes, that would be one way. Another would be to take GLP- drugs, I guess. I don't know. I know a lot of people who are taking the drugs. And I'm always very interested in hearing from them what their experience with the drugs is like.

DR. DENNIS BALLWIESER Okay, so the thing about all the things that you told me what the individual might do always have one caveat in my point of view and that is you have to have the money and the time to be able to do that and a lot of people simply can't afford it and if you're working two or three jobs or if you take care of parents that need help or have small children and might make it very hard to. Do that in hours in a day. So is there anything that you would give people as an advice who lack the money to make those healthy choices in the supermarket what they have as a defense?

PROF. MARION NESTLE Well, I want everyone to understand how the food environment is structured. I think it makes it easier if you understand that the entire food system is set up to try to get you to gain weight, then maybe it'll be easier to resist in some way. If you understand the extent of the marketing that goes into trying to get your children demand certain products. Then maybe it'll make you angry enough so you'll fight back.

DR. DENNIS BALLWIESER Okay, so it comes to that if you have small children, you should do everything that you can to avoid them having as much contact to processed foods as they usually would have.

PROF. MARION NESTLE Well, you need to teach the media literacy from a very young age, a very, very young age. You must teach them the difference between advertising and content. And understand that when they see those cartoons and those games there's somebody there that wants them to buy something.

PROF. MARION NESTLE And teach them that so they understand that very well.

DR. DENNIS BALLWIESER Okay, and if you're an obese adult, then you might try to get access to the new medications that are out there and at least try to lose...

PROF. MARION NESTLE If you can't do it any other way, yeah, sure, see how it goes. Start with a low dose, oh dear. I mean, the side effects of these drugs, one of them is you're not interested in food anymore.

PROF. MARION NESTLE They quiet the food, what's called the food noise. And people tell me they're just not interested in eating. But they're not interested eating junk food. It's specific. That's very interesting. It's very, very interesting, very, very interesting

DR. DENNIS BALLWIESER So it has to change.

PROF. MARION NESTLE It's selective, so they don't want to eat high sugar foods. They don't wanna eat high fat foods. They wanna eat healthfully.

DR. DENNIS BALLWIESER There are people out there who are writing about obesity as a psychiatric disorder, and what you were saying about GLP- agonists and what the drugs are actually doing, that seems to make a lot of sense, doesn't it?

PROF. MARION NESTLE It does make a lot of sense. I mean some people gain weight very easily. Let's say you have a population of people who overeat, everyone will gain weight, everyone, but some people will gain much more weight than others.

PROF. MARION NESTLE And so those are the people who have the most trouble with this. You know, for somebody like me, I can take it on and off very, very easily without even thinking about it, because I don't have a weight problem. But lots of people have a problem where the weight just sticks. And for them it's much harder.

DR. DENNIS BALLWIESER Yeah, we might have to differentiate the people who are obese into different groups and different backgrounds of the illness that they actually have.

PROF. MARION NESTLE Well, presumably if you have a doctor prescribing these drugs that doctor is going to work with you as an individual. Should take care of that. Good luck with that.

DR. DENNIS BALLWIESER That's the same in the U.S. As in Germany as well. So to get back to me standing in the supermarket aisle, you said that you read a lot of labels when you're in the supermarket. What should I be on the lookout for as a normal human being, not a food politics nutritionist when I read the labels on the supermarket?

PROF. MARION NESTLE Well, in your particular case, calories are an issue, so that's what you would look at. You know, I think labels are fun, and sometimes they're hilarious, because I think marketing is sometimes very amusing. I think, really? Some marketer dreamed up this? But I look for calories, I look at sugar. Nobody needs more sugar.

DR. DENNIS BALLWIESER And are there warning signs in specific supermarket aisles where people should always be aware of?

PROF. MARION NESTLE Well there are in Mexico, products that are high in fat, sugar, salt and calories have warning labels on them.

PROF. MARION NESTLE I mean, great big black warning labels on them.

DR. DENNIS BALLWIESER That would be something that you would advise?

Oh, I think it's very good idea.

PROF. MARION NESTLE Although it is quite shocking to go into a Mexican supermarket and see how many products have warning labels on them.

DR. DENNIS BALLWIESER Because if you transfer that to the United States, it would be the same over here.

PROF. MARION NESTLE It would be exactly the same.

DR. DENNIS BALLWIESER And do they have actual results of that?

PROF. MARION NESTLE They certainly find a decrease in purchases of those products and what they're trying to show that decreased purchase leads to better biochemical indicators of health, leads to weight loss, but they're having trouble showing that.

DR. DENNIS BALLWIESER Finally, if I'm trying to talk to companies in Germany, which probably won't wanna talk to me, but if I read their policy papers, there seems to be no science that supports the idea that there is something like an unhealthy food out there. Everything is fine as long as you make the right choices.

PROF. MARION NESTLE Well, let me say again, eating less is very bad for business. And once you understand that, everything that food companies do make sense. Food companies' job is to sell products.

DR. DENNIS BALLWIESER But to establish that, there is actual science that shows that there's good foods and not so bad.

PROF. MARION NESTLE Right, there's certainly science that shows that balancing calories is a really good idea, that fruits and vegetables are healthy, that eating too much junk food is not healthy. There's lots of science that show all of that. But one of the things you do if you're a food company is you follow the tobacco industry's playbook and you cast doubt on the research.

DR. DENNIS BALLWIESER What happens to researchers that try to show otherwise?

PROF. MARION NESTLE Well, they don't get money from food companies for one thing, and sometimes they get into very big trouble.

DR. DENNIS BALLWIESER I read in your books that they actually have been sued and there have been other ways to try to silence them.

PROF. MARION NESTLE Well, yes. Again, if you're a food company, it's your job to sell products, and you do that in every way you possibly can think of. And you follow the tobacco industry playbook, because the tobacco industries set the rules for how you try to convince people that smoking cigarettes really isn't harmful. It's your fault if you smoke. We're not putting a gun up to your head forcing you to smoke. Oh, the research is done on too few people. The research didn't follow long enough. It didn't control for other bad habits that people might have. So you cast doubt on the research. You buy your own research. You fund research that's likely to give you the kind of results you want. You blame personal responsibility. You indulge in self-regulation. You don't have to regulate us. We'll take care of it. We just won't sell cigarettes in places. And then behind the scenes, you lobby. You make sure that your legislators don't pass legislation that might impede sales. You do all of those things. Food companies do the same.

DR. DENNIS BALLWIESER Should we regulate the food companies like we did with the tobacco companies?

PROF. MARION NESTLE You know, I think it's time we did.

DR. DENNIS BALLWIESER Is there a reason why some of the food companies at least have been owned by tobacco companies?

PROF. MARION NESTLE Yes, well there was a period when Altria, which owned Philip Morris, owned a company that owned Kraft Foods, but that didn't last very long. On the other hand, while they owned Kraft foods, they taught Kraft foods how to market.

DR. DENNIS BALLWIESER I think people have a hard time thinking about something as benign as a food company, which is there to serve me and to give me nutritious foods that taste excellent, shall be a villain like the tobacco company.

PROF. MARION NESTLE It's very hard to think that way and also it's food is different from tobacco. Tobacco is one product.

DR. DENNIS BALLWIESER And I can stop smoke, right?

PROF. MARION NESTLE With one message, one message. Don't smoke.

DR. DENNIS BALLWIESER I can't stop eating.

PROF. MARION NESTLE You cannot stop eating, you die. So you have to eat, it's a question of what and how much. And there, if you go into a supermarket, it looks like there are 50.000 different food companies. In fact, most of those products are owned by about ten companies. But people don't realize who the manufacturer is, the ultimate owner is of all of those different brands. And we love these products. We love to eat them. And so it's hard to believe that anything that's so good could possibly be bad for and it's not if it's consumed in small enough amounts. It's not in moderation. It's only bad for you if that's all you're eating.

DR. DENNIS BALLWIESER You're supposedly your professor emeritus, right?

PROF. MARION NESTLE Yes, I'm retired.

DR. DENNIS BALLWIESER Yes, very much so. What drives you still? I can't not see that you are absolutely fascinated by food and nutrition. What still drives you after all those years?

Oh, it's so much fun.

PROF. MARION NESTLE Everybody eats, it's a way to relate to everybody. And also it's way to look at really important social problems through the lens of food. There's almost nothing that food doesn't connect to in some really profound way. From climate change all the way down to personal health. So it's enormously entertaining for me. I find it fascinating. I find the research fascinating because it's so difficult to do research in this field. You can't control people's diets. You can’t lock them up for long enough to be able to do a really well-controlled experiment. You have to depend on what people tell you they eat and, oh, they have such a difficult time remembering. You know, I certainly do. And I find the ambiguity of the research, the fact that everybody eats, the way that food connects to everything in society to be absolutely fascinating.

DR. DENNIS BALLWIESER If you had to distill all that you know about food and nutrition into one message that you can pass on to the next generation, what would it be?

PROF. MARION NESTLE I would plagiarize from the journalist Michael Pollan. Eat food, not too much, mostly plants.

DR. DENNIS BALLWIESER Thank you so much, Marion Nestle.

DR. LAURA WEISENBURGER Das war das ganze Interview. Wie schon gesagt, in den Shownotes findet ihr auch den Link zu dem Artikel auf Deutsch dazu. Wenn ihr da nochmal reinschauen wollt. Morgen geht es weiter mit dem Interview mit Dr. Matthias Berger von “Dr. Oetker” und ab dem 01.09. hört ihr uns wieder ganz normal in unserem werktäglichen Gesundheitsupdate.

SPRECHER Ein Podcast von gesundheit-hören und Apotheken Umschau Pro.