A Dietitian's Guide to the "Make America Healthy Again" Movement

Some prefer scalpels. Some prefer hammers. Which are you?

You use a scalpel. I prefer a hammer. My man goes, or no one goes.

That line of dialogue comes from actress Angela Bassett playing the role of CIA Director Erika Sloane delivering an ultimatum in the film, Mission: Impossible - Fallout. The Mission: Impossible franchise has delivered a reputable share of action and thrills throughout its nearly 30-year history, but the 6th installment from 2018 saw a uniquely entertaining matchup in the form of Ethan Hunt (played by semi-immortal Tom Cruise) against August Walker (portrayed by the Man of Steel, Henry Cavill). In addition to providing some worthwhile entertainment, the film’s characterization of Hunt as a scalpel and Walker as a hammer provides a serviceable analogy into the psyche and rationale behind how some people address significant problems.

The world has no shortage of problems to address (it has ever been thus…), but at present, there is growing public alarm for the rising prevalence of chronic disease in the United States. While healthcare practitioners and dietitians have long been aware of this trend, media fanfare to key figures has brought the subject of chronic illness to center stage, and within this zeitgeist, we have witnessed the birth of the Make American Health Again (MAHA) movement. A superficial analysis of MAHA’s key issues — which include the chronic disease epidemic — would presumably draw widespread support. But here is the rub. The reaction to the MAHA movement has been, and this is putting it mildly, somewhat polarized. The profession of dietetics exists uniquely to optimize human health, but plenty of dietitians stand on either end of the aisle in regards to MAHA, with both ends looking at each other and simultaneously thinking, What are you doing over there?

Curious, curious, curious. Why is this the case, this split? Well, in the spirit of consensus, here is a brief consideration of the facts that underlie the MAHA movement, along with an interpretation of those facts as voiced by both aisles. A key to understanding all of this may exist with a reiteration from CIA Director Sloane.

Some prefer scalpels. Some prefer hammers. Which are you?

The Hammers

The MAHA Super PAC was officially launched on September 4th, 2024, with the intent to convince Robert F Kennedy’s supporters to vote for Donald Trump:

The MAHA Super PAC is essentially a machine we’ve built to turn contributions into powerful messages that resonate with RFK Jr.'s supporters. Our goal is to ensure that as many of them as possible vote for Trump, helping to win the election and bring RFK Jr.'s policies to the forefront of national governance.

Shortly after dropping out of the presidential race, Kennedy offered an endorsement of Donald Trump. Kennedy often expressed his respect for Trump, and believed that their ideological alignment would leave room for Kennedy in the new administration. He was right, as Trump formally nominated Kennedy to serve as the secretary of Health and Human Services (HHS).

Since then, MAHA has evolved and set forward its list of key issues.

1. The Chronic Disease Epidemic

2. Regenerative Agriculture

3. Habitat Preservation

4. Combatting Corporate Corruption

5. Removing Toxins from the Environment

At a glance, there is nothing unseemly about any of these issues. But the key operator, Kennedy himself, goes much further in his propositions and claims. Kennedy has shown no reservation in his disdain of current and previous health administrations. He has literal lists (which he has shared with the public) of treatments, practices, or measures he wants abolished or promoted.

You don’t want to make Kennedy’s list…

Kennedy does not present himself as a whispering kitten, but as a blunted and durable weight, fixed to a handle in order to multiply the strength of its wielder. In other words, Kennedy is a hammer, and if you find yourself in support of Kennedy and MAHA, you are just like Director Sloane. You prefer a hammer.

The Vindication of the Hammers

There is a particular catharsis which comes from the unimpeded use of a hammer. The human psyche often finds mental relief in the release of energy via breaking stuff. How else do you explain the popularity of “Rage rooms”, where participants are given free range to deliver a dose of controlled destruction to random objects? Sometimes, it just feels good to smash something. Just ask the Hulk.

Within both the public and professional realms, there is a lingering disillusionment with scientists that started during the COVID-19 pandemic. Public trust in scientists began to dip in 2020, and this trend finally appeared to undo itself by October of 2024.

This disillusionment, coupled with decades-long distrust in government, is reaching new audiences and prompting new calls to action, whether that be sweeping revisions to established institutions or outright abolition of entire agencies. While the list of grievances that prompted this disillusionment did not start in 2020, the COVID-19 pandemic was a seminal event that displayed acts of ineptitude, incompetence, and outright corruption that were catastrophic on public trust in science.

There is no shortage of events which allow anyone, dietitian or not, to walk in the shoes of someone eager to pick up a hammer. People did not like being forced to choose between their employment and a medical treatment. Public parks (as in, large outdoor spaces) being closed under the pretense of public safety, and then arresting park attendants, was always bad optics. Elected officials issuing public directives, and then ignoring those same directives did not sit well with voters. Many people would have gladly taken the risk of an infection if it meant their loved ones did not have to die alone.

But the resentment and frustration bubbles over public health, into the space of food and dietetics. Critics point out how since the late 1970’s, obesity and chronic disease rates have continued to rise. Heart disease and cancer remain the top causes of death in the United States. Despite these statistics, human health rarely seems to be a pressing issue in the halls of congress or corporate media outlets. “How can we be spending nearly a quarter of the federal government’s budget [1.61 trillion dollars] on health and still see these outcomes?” is a question that receives many echoes. Where exactly does all that money go?

So now, for the first time in recent memory, you have political figures center stage who are making human health a platform. It is, as one dietitian stated, “… a much needed breath of fresh air from all the corruption.” Frankly, there are many character defects people are willing to overlook, if that person is holding a hammer and pointed in the desired direction.

However, there is much that can be lost when “Scorched earth” becomes your point of policy. In your haste to build something new, much of what is good can be damaged, and what’s to reassure anyone that the person holding the hammer will actually know how to rebuild? If MAHA’s tactics and targets feel extreme, you probably prefer a scalpel.

The Scalpels

Scalpels can cause significant damage in their own right, but not at quite the scale of a hammer. Also distinct, anyone with functioning muscles can pick up and swing a hammer, but the scalpel requires patience, training, and restraint for optimal usage. While changes in present institutions are most certainly necessary, the scalpel will argue that these changes should be calculated and precise in their implementation.

In this, you can see how the scalpel perspective favors empiricism, clinical expertise, and a record of success in the intended outcome.

There is undeniable validity in this perspective, as scientific advancements have paved the way for improvements in quality of life and medical treatments. While they are leading causes of death, cancer and heart disease mortality rates have been going down for over two decades.

Trends in premature HD mortality

Advancement for treatments of other diseases and threats to life have seen dramatic improvement, as subsequent generations build upon the practices of their progenitors. That is visible progress, the likes of which should promote reticence towards talk of tearing it all down and starting over.

As one critic of the MAHA movement stated, “It’s hard to really pinpoint what time time period that word ‘again’ is referring to in the MAHA movement.”

It is also fascinating to note how the spokesperson of the MAHA Super PAC, Jeff Hutt, responded when asked what time time period MAHA was hearkening to for when American health was better:

That’s a great a question… I’ve never been asked that.

A Cautionary Tale from the Scalpels

It is a simple principle of the cosmos — it is always easier to destroy than it is to build. So if destruction is being prescribed, be absolutely certain of what it is you are destroying and what will be built in its place.

This is the warning of the scalpel. Kennedy, and MAHA by extension, lack the training and track record which qualify either to make impactful decisions about human health. Kennedy’s professional background is as a lawyer, however, it is not a stretch to simply define him as an environmentalist. His public persona began in the mid-80’s when he started working for an environmental NGO called the Hudson Riverkeeper, eventually serving as their chief prosecutor. Most of the books he has published are subjects of litigation surrounding environmentalism. He was nearly appointed by President Obama to lead the EPA.

Consider this, and go review those key issues that come from the MAHA movement. With the exception of the mention of chronic disease, all of those issues strike the note of environmental protection, rather than human health. It raises questions of where MAHA’s priority actually lay, or whether the health concerns are a false face for alternative objectives.

Kennedy makes lofty claims about food and nutrition that are outright incorrect. He claims seed oils are toxic, but extensive research demonstrates that when controlled for caloric intake, the elevated consumption of seed oils are associated with reductions in cancer and heart disease. He claims fluoride is dangerous, but high-quality data reports appropriate fluoride intake reduces dental caries.

None of this, by the way, is even approaching his many other beliefs that are not evidence-based nor conducive to human health. Kennedy is on record stating that:

There’s no vaccine that is safe and effective

Look at your own aisle

The purpose in presenting these facts and perspectives should not be construed as an attempt to make people cross the aisle. Instead, wherever you stand, would it really be so difficult to critically analyze the ground you are standing upon, and perhaps answer a few uncomfortable questions?

Not sure where to start? Try these.

Why is it that for the first time in decades, the US average lifespan experienced a multi-year decline?

If chronic disease health outcomes are so central to the MAHA movement, why do its proponents platform so many other unrelated topics?

Why are people turning to alternative sources of information for health guidance?

How will removing select additives lead to a reduction in heart disease, or obesity rates?

One final thought. Whether or not he is appointed as HHS secretary, Kennedy is not going anywhere. The recent letter signed and submitted by Nobel laureates, urging senators to not vote for Kennedy belies a complete misunderstanding of how the federal government works. The office of the president has discretion to hire anyone that it wants, for whatever role. If not appointed, Kennedy will simply be made an advisor who offers the desired winks and nudges where necessary.

What that means is, your work as a dietitian, the work of promoting human health through the power of food and nutrition, will still be needed. Whatever the direction the next four years go, set aside your gloom and get to work. People will still need to eat, evidence-based practice will still be the best approach, and the choice between the scalpel or the hammer will still pale in comparison to the competence of the person who chooses either one.

So choose wisely.