#583：超加工食品与食品环境改善——Kevin Hall博士

你好，欢迎收听Sigma营养电台。

Hello, and welcome to Sigma Nutrition Radio.

我是丹尼·列侬。

My name is Danny Lennon.

非常欢迎您收听本期播客。

You are very welcome to the podcast.

这是第583期节目。

This is episode 583.

今天我将与凯文·霍尔博士对谈，他是国际知名的人类营养学、新陈代谢和肥胖症研究专家。

And today, I'm gonna be talking with doctor Kevin Hall, who is an internationally renowned expert in human nutrition, metabolism, and obesity.

长期以来，他一直站在重要研究的最前沿，这些研究涉及环境如何影响饮食行为、营养如何影响新陈代谢和体重调节，我们今天将讨论其中部分开创性成果。

And he's been at the forefront of really important work over a long period of time that relates to how our environment shapes certainly dietary behaviors, how things like nutrition affect our metabolism and body weight regulation, and has really been at the forefront of incredibly important work, some of which we will be discussing today.

他此前在美国国立卫生研究院（NIH）工作二十余年，主导的研究结合了严格控制的代谢病房试验、先进神经影像技术、数学建模等多种方法，深入探究肥胖症及饮食相关慢性病的驱动因素。

He previously worked at the National Institutes of Health or the NIH for over two decades where he led research that combined tightly controlled metabolic ward trials, some advanced neuroimaging, some mathematical modelling, and various other types of studies to really look at some of the drivers of obesity and then therefore diet related chronic diseases.

他最近与合著者朱莉娅·贝鲁兹共同出版了《食物智能》一书，探讨了我们进食时发生的诸多现象，并针对当前营养与健康领域的热点话题提出了见解。

He has recently published a book titled Food Intelligence along with his coauthor Julia Bellutz, which looks at a number of the things that happen when we consume food and takes on some of the real big talking points in nutrition and health right now.

在这次特别的讨论中，我们将重点关注一两个在学术界乃至更广泛领域都极为重要的话题。

In this particular discussion, we're gonna focus in on one or two discussion points that are really important both within academia as well as more broadly.

其中一个话题当然与超加工食品有关，霍尔博士在这方面进行了多项重要研究，对此有着独到的见解。

One, of course, relates to ultra processed foods and doctor Hall, having done several really important studies in this area, has an informed position on this.

因此我们将探讨当前的研究证据，以及学术界目前存在的一些争议点。

And so we're going to talk through where we currently are with that evidence and maybe some of the debates that are going on within academia at this particular point.

我们还会讨论食品环境及其与食品政策等议题的关联，这是霍尔博士在公共场合...

We'll also talk a bit about the food environment and how that relates to things like food policy, which publicly Doctor.

由于NIH对员工讨论工作范围之外政策话题的标准限制，霍尔博士在任职期间一直未能深入探讨这些内容。

Hall hasn't really been able to discuss over the period of time that he was working in the NIH for simply the standard limitations that are placed on employees about talking about policy beyond their actual work.

我们将在节目中展开这些讨论，希望您会喜欢。

We'll get into some of that discussion here, which I hope you will enjoy.

对于播客的高级订阅用户，您将获得本期节目的详细研究笔记。

For those of you who are premium subscribers to the podcast, you will get detailed study notes to accompany this episode.

您只需点击描述框中的链接，即可获取这些资料以及完整的节目文字稿。

You can just click through in the description box and get access to those as well as a full transcript to the episode.

如果您正在收听本播客的公开频道，并希望从播客收听中获得更多收获，将其作为教育工具，不妨了解一下我们的Sigma Nutrition高级会员服务。

If you are listening on a public feed of the podcast and you want to get more out of your podcast listening and use this as an educational tool, then maybe see a bit about what we've got going on with Sigma Nutrition Premium.

我会在描述框中提供一些详细信息，或者您可以直接访问sigmanutrition.com查看高级订阅的权益。

I'll link up some details in the description box right now, or you can just check that out over on sigmanutrition.com and you'll see what a premium subscription gets you.

除了每期播客的学习笔记外，您还将获得对话后的总结片段，以及每月专属的高级会员专享节目。

In addition to study notes for each of our podcast episodes, you'll also get summary segments that appear after the conversation, and then you will also get premium exclusive episodes each month as well.

这也是本节目主要的运营支持方式。

And it is the primary way that this show is supported.

我们不投放广告，因此能够持续运营全靠忠实听众和通过高级订阅支持我们的您。

We don't run ads, and so the primary way that we keep running is thanks to our loyal listeners and those of you who support through a premium subscription.

在此感谢所有持续支持我们的听众。

So thank you for anyone who continues to do that.

除了今天提到的相关资源外，描述框中还链接了我们提及的所有研究资料以及Hall博士此前在本播客的四次露面内容。

So that is all linked in the description box in addition to any other relevant resources today to any of the studies that we mentioned to some of the previous appearances that doctor Hall has made on this podcast.

我记得Hall博士之前应该来过四次。

I believe there's four previous appearances.

所以如果你喜欢听霍尔博士的分享，可以去看看那些往期节目。

And so if you do like listening to Doctor Hall, you can go and check those out.

我会在描述区列出那些内容，所有相关链接都在单集页面上。

I'll put a list of those in the description, and any of that stuff is all linked up over on the episode page.

只需点击进入，就能获取所有相关资源。

So just click through there, and you'll get all of the relevant resources.

那么，让我们开始与凯文·霍尔博士的对话吧。

So with that, let's dive into this conversation with doctor Kevin Hall.

霍尔博士，欢迎您的到来。

And here we are, doctor Kevin Hall.

非常感谢您再次参与我们的播客。

Thank you so much for joining me again on the podcast.

这是我的荣幸。

It's a pleasure.

谢谢再次邀请我。

Thanks for having me again.

是啊。

Yeah.

我前几天才查了一下你第一次上播客的时间，发现那已经是十年前的事了，当时是我们合作的第一期节目。

I think I only checked actually the other day to see the first time you were on the podcast, and I think it was over ten years ago now when we did the first episode that you were on.

这期间我们又录了三期。

And I think we've done three in the meantime.

时间过得真快，感觉有点不可思议，不过你随时都欢迎回来做客。

So it's crazy to me how a quick time goes by, but nevertheless, you are always welcome back.

很高兴你能抽时间参与这次录制。

So I'm glad you've given up the time to do this.

非常感谢。

I appreciate it.

谢谢你提醒我比实际年龄更老这件事。

Thanks for making me feel older than I really am.

所以

So

别客气。

Not at all.

或许有些听众之前没有机会听过您的节目，或者出于某些原因对您不太熟悉。

For perhaps people listening who maybe haven't had a chance to catch you on any of those previous appearances or for one reason or another are not familiar with you.

您能简单介绍一下自己，包括您的背景以及目前正在从事的工作吗？

Can you give us the brief introduction to who you are, your background, and then anything that you've got going on at the moment as well?

好的，没问题。

Yeah, sure.

我的本科和博士学位实际上是物理学方向，期间我主要从事心律失常等问题的数学建模研究。

So my undergraduate and PhD degrees are actually in physics where I spent time doing mathematical modeling of cardiac arrhythmias and things like that.

博士毕业后我加入了一家小型生物技术公司，负责带领团队开发二型糖尿病的计算机模拟模型，这是我首次接触内分泌学、代谢学和营养科学领域。

I joined a small biotech company right after my PhD, where I was given the task of developing a computer simulation model of type two diabetes with a team of folks, which was my first sort of introduction to endocrinology, metabolism, nutrition science.

那真是一次大开眼界的奇妙经历——尝试在计算机中建立动态系统模型，模拟人体如何在内分泌调控下处理碳水化合物、脂肪和蛋白质，并在不同器官间进行转运。

And that was just like the most eye opening and fascinating experience trying to stimulate inside a computer in a dynamical systems model of how our body handles carbohydrates, fats and proteins and shuttles them around between different organs under endocrine control.

我就是在那里真正爱上了这个领域，并有幸在华盛顿特区附近的美国国立卫生研究院获得了终身教职。

And I sort of really fell in love with the field there and was fortunate enough to get a tenure track position at the National Institutes of Health just outside Washington, D.

在华盛顿特区附近，我建立了自己的实验室，最初只是延续那些数学建模工作，但现在更多转向研究长期发展过程中身体成分的变化、肥胖症的形成机制，以及各种减肥方案和生活方式干预措施。

C, where I started my own lab, initially just continuing that mathematical modeling work, but now extending more towards body composition change over long time periods in development of obesity and different kinds of weight loss programs and lifestyle interventions.

这样工作了几年后，我开始在美国国立卫生研究院临床中心的代谢病房开展临床试验。

Did that for several years and then started to run clinical trials at the metabolic ward at the NIH Clinical Center.

在那里进行了多项试验，包括住院患者的受控喂养研究——受试者与我们同住数周甚至数月，我们通过操控他们的饮食环境来测量其进食情况，或直接控制其饮食以观察他们对不同受控喂养模式的生理反应。

Did a bunch of trials there, controlled human feeding studies inpatient where people stayed with us for weeks and months at a time, and we manipulated their food environments and measured what they ate or we controlled what they ate and measured their physiological responses to different controlled feeding patterns.

后来在四月份，我毫无预兆地离开了美国国立卫生研究院。

And then I guess unceremoniously in April, I left the NIH.

我选择了提前退休，因为政治因素干扰了我们实验室部分数据的发布工作。

I took an early retirement option due to some political interference in our ability to report some of some of the data coming out of our lab.

我看不到继续在国立卫生研究院从事这类科研的前景。

I didn't see a path forward to be able to continue that kind of science at the NIH.

这实在令人遗憾。

Unfortunately.

因此在任职二十一年后，我决定离开。

So after twenty one years, I decided to leave.

从那以后我一直在做些咨询工作，同时寻找下一份差事。

I've been doing some consulting since then and looking for my next gig.

我们拭目以待最终会落脚何处。

We'll see where I end up.

对于想深入了解某些具体研究的听众，我们有完整节目专门讨论过其中部分内容。

And for people who want to go and hear more about some of those specific studies, we have full episodes covering some of those.

我会在描述中附上相关链接及全文，为大家提供更多背景信息，强烈推荐大家去查阅。

I will link to those in the description as well as the full text of those to give people more context, and I highly recommend you go and do that.

今天有几个话题希望能与你探讨。

There's a few things I was hoping to talk to you about today.

其中一些话题与你新书中提出的概念相关——我们稍后自然会讨论到——但也包括你直接参与过的研究领域。

Some of these are related to some of the concepts you raise in your recent book that we'll certainly get to a bit later on, but are also generally topics that you have done work directly in.

记得我们之前某期节目曾讨论过你关于超加工食品的试验案例。

I think on one of our previous episodes, we talked about one of your trials on ultra processed foods as an example.

这个话题当前不仅在营养学界备受关注，在更广泛领域也极富讨论价值。

And that of course, is a hugely interesting topic both within nutrition academia right now as well as outside more broadly.

这个话题确实存在许多合理的分歧观点。

And it's one where there's many conflicting opinions with good reason.

我认为你的研究清楚地表明，在超加工食品为主的饮食与最低限度加工食品为主的饮食之间，我们可能观察到热量摄入差异对体重增加的影响。

I think your work really showed us that based on a diet that was more with ultra processed foods than minimally processed, we could see this difference in caloric intake potentially for weight gain.

随之而来的问题就是探究原因并分析这些机制。

Then the subsequent question comes of why and looking at some of these mechanisms.

但在深入机制之前，我真正想请教你的是：理解这些机制对后续研究的重要性。

But before we get to the mechanism themself, what I'd really like to ask you about is the importance of understanding those mechanisms before going any further.

因为我认为这最终会成为争议焦点——有些极端观点可能会说：看啊

Because I think this ends up being a contentious point that there are some people on one end of the extreme that might say, well, look.

我们已经发现这类食品与问题的关联性

We see this association with this general group of foods.

现在就需要从政策或其他层面采取行动

We need to start doing something about it now, policy wise or otherwise.

而另一种立场则是：好吧...

And then there's another position that's like, okay.

我们确实看到了这种关联，但我们必须非常清楚地了解这些机制，以免在制定政策或其他决策时误入歧途。

We do see this association, but we need to be really clear on what those mechanisms are so that we don't fall in the trap of misstepping when we are taking policy decisions or otherwise.

您能否谈谈您在这个问题上的立场，以及为什么从机制上理解这个问题对我们来说如此重要？

Could you maybe give us an idea of where you fall on this and this search for mechanistically understanding this, why that is an important question for us?

我倾向于认同双方的观点。

I tend to agree with points on both sides.

不出所料，我认为双方都提出了非常非常合理的论点。

Not surprisingly, I think they both make very, very reasonable points.

我认为过去几十年里，我们的食品体系发生了改变，尤其是在英国、美国、加拿大、澳大利亚等地，我们看到食品供应中超加工食品类别的热量显著增加。目前研究领域对超加工食品只有一个被广泛接受的定义，那就是NOVA分类系统。

I think that we have experienced over the past several decades a change in our food system in a way that has, especially in The UK and The US and Canada and Australia and other places, we've seen this rise in the number of calories that are in the food supply that are in this ultra processed food category, which was really, there's only one definition right now that I would say is generally accepted in research terms, in terms of what ultra processed foods are, that's this NOVA classification system.

这是一个非常宽泛的定义。

It's a very broad definition.

我认为这正是争议的根源所在，对吧？

I think that that's where some of the contention comes in, right?

因为我觉得人们会争论说，不应该用一刀切的方式对待所有超加工食品，并在政策和法规等方面对它们采取同等措施。

Because I think that folks will argue that you shouldn't paint with a broad brush all ultra processed foods and target them equally for policies and regulations and those sorts of things.

我认为这是一个完全可行的观点。

I think that's a perfectly viable thing.

而这正是机制研究的意义所在，对吧？

And that's where I think the mechanisms come in, right?

如果我们能理解这些观察性研究中将高比例超加工食品饮食与各种负面健康后果（如肥胖、二型糖尿病及后续的心血管代谢疾病等主要问题）关联起来的机制，那么我们能否针对性地只对部分超加工食品采取措施？

If we could understand the mechanisms by which many of these observational studies have linked diets high in ultra processed foods with all sorts of negative health consequences, obesity, type two diabetes, and downstream cardiometabolic disease being some of the main ones, what could we do if we understood the mechanisms that would target only a subset of ultra processed foods?

有学者认为，许多机制可能正是我们长期讨论的那些因素，对吧？

And some folks have argued that many of the mechanisms might be the things that we've always talked about, right?

即那些高添加糖、高饱和脂肪、高钠，同时缺乏膳食纤维、全食物、豆类和全谷物等成分的食品。

Which are the foods that are high in added sugars and saturated fat and sodium and low in fiber and low in whole foods and legumes and whole grains and things like that.

事实上，NOVA超加工食品分类体系有个耐人寻味的特点——它对营养成分持中立态度，对吧？

And indeed, one of the kind of interesting things about the NOVA classification system for defining ultra processed foods is that it takes a sort of nutrient agnostic view, right?

这个体系完全不提及钠、饱和脂肪或添加糖的含量。

It doesn't mention sodium or saturated fat or added sugars.

它真正关注的是食品加工的深度、目的及其配方，以及这些因素如何影响我们的整体饮食环境。

It's really looking at the extent and purpose of processing and formulation of those foods and how they play a role in our overall food environment.

因此我认为，我们已可利用现有关于不健康饮食的知识，即那些需要关注的营养素以及水果蔬菜摄入不足等问题。

So my view is that we can already use what we know about an unhealthy diet, meaning those nutrients of concern and the low amounts of fruit and vegetable intake, for example.

我们可以在这一范式上叠加超加工食品视角，同时探索新的机制性原因——例如高超加工食品饮食可能导致过量卡路里摄入，但也可能引发肠道功能障碍、炎症等与能量摄入无关的其他后果。

And we can apply the ultra processed lens to that paradigm, as well as seeking new mechanistic reasons by which diets high in ultra processed foods might drive, for example, excess calorie intake, but may also drive other things like gut dysfunction and inflammation and other sorts of outcomes that are independent of energy intake.

通过将现有知识与精心设计的试验中产生的新数据相结合，我们就能精准锁定食品供应链中真正有害的元凶，从而制定相应政策。

And by using existing knowledge with new data that we can generate in well designed trials that we'll be able to target in and hone in on the real bad actors in the food supply and thereby introduce policies.

但我想说的是，其实我们已经掌握了很多关于这些有害元凶的信息，对吧？

But I guess what I'm saying is that we already know a lot about what some of those bad actors are, right?

关于高糖摄入的危害性，我们一直争论不休。

So we've had constant arguments about the deleterious effects of high sugar intake.

关于某些来源的高饱和脂肪和高钠摄入的危害性，我们也持续争论多年。

We've had constant arguments about the deleterious effects of high saturated fats from certain sources and high sodium intakes.

超加工食品及其相关讨论的独特之处在于，它比过去任何关于糖、盐或饱和脂肪的讨论都引发了更多政治关注，激起了更强烈的基层愤慨并积累了更多政治资本来采取行动。

The interesting thing about ultra processed foods and the discussion around it is that it has generated more sort of political attention, more grassroots outrage and capital, political capital to do something than any of the discussion about sugar or salt or saturated fat has in the past.

我认为明智之士正在表示：我们可以利用这种政治意愿，真正开始针对那些早已被证实对不良饮食结构起重要作用的因素采取行动。

And I think that smart folks are saying, Okay, we can take advantage of that political will to really start to target some of the things that we've already known are playing a big role in poor diets.

一个非常具体的例子是加利福尼亚州最近通过的关于学校午餐计划的新法律，如果你查看他们的定义，他们试图界定有害的超加工食品。

A very concrete example of that is the new law that was passed in the state of California on school lunch programs, which if you look at their definition, they've tried to define harmful ultra processed foods.

其中一大类就是过量的饱和脂肪、钠、添加糖以及一堆添加剂，这些基本上都是超加工食品的标志。

A whole host of those things are excess saturated fat, sodium, added sugar with a bunch of additives are basically markers of ultra processed foods.

我认为他们甚至没有说这些添加剂本身必然有害或对健康有负面影响。

And I don't think they're even saying that those additives per se are necessarily negative, have negative health consequences.

这基本上是将政策瞄准大型食品制造商和工业化食品生产的一种方式，这些生产会影响公共健康，而不是简单地说那些超加工食品的标志物才是真正的罪魁祸首。

There are basically ways to target your policies to the big manufacturers and industrial production of foods that is that's going to impact public health as opposed to saying, yeah, those those markers of ultra processed foods are the real bad guys.

我认为这就是最近产生很多困惑的地方，有些人把人工色素或合成色素当作潜在的有害因素来针对，而实际上它们只是超加工食品的标志物。

And I think that's where a lot of confusion has arisen in recent days, where you see folks targeting artificial colors or synthetic colors as the potential bad players, when they're really just markers of ultra processed foods.

或者说，我知道我们目前没有足够的研究表明这些色素是有害的、中性的，甚至可能是有益的，谁知道呢？

Or I know, we don't have good studies to suggest that those colors are deleterious or neutral or maybe even beneficial, who knows?

但我想说的是，在如何界定超加工食品这一类别以及它们导致健康问题的机制方面，存在一些误解。

But I think the point is, is that there's a little bit of misconfusion about what we're using to identify this category of foods of ultra processed foods and the mechanisms by which they drive poor health.

这种困惑可能导致奇怪的政策，比如‘我们要针对含有高果糖玉米糖浆的食品，用蔗糖替代它们，好像这对公共健康会是一个重大胜利’这样的想法。

That confusion can lead to strange policies like, oh, what we're going to do is we're going to target foods that have high fructose corn syrup as an ingredient, we're going to replace them with cane sugar as if this is going to be a big win for public health.

对吧？

Right?

我们掌握的所有数据都表明，人体对这两种物质的代谢处理方式并无差异。

All the data that we have suggests that there's no metabolic difference between the way that our bodies handle these two substances.

这正是个绝佳例子——比如碳酸饮料，即便你做了这种替换，我们也可以高度确信地假设这对公共健康几乎不会产生任何影响。同理，如果我们用人造色素替换天然色素，得到的食品由于其营养成分构成，仍可能导致过度摄入或有害影响。

And that's a perfect example where you see with sodas, if you make that substitution, we would hypothesize that there's virtually gonna be no impact on public health with a stronger degree of confidence or the same if we replace an artificial coloring with a a natural coloring, let's say, we still have a food that due to its nutrient profile otherwise is likely going to lead to overconsumption or deleterious effects.

因此我认为，这或许可以成为一匹特洛伊木马，帮助我们开始关注那些可能已被人们忽视的营养素问题。

And so I think it's useful thinking about this as maybe that Trojan horse that gets us away to start targeting some of these nutrients that maybe people are bored with.

还有些人会陷入自然主义谬误，比如认为添加的天然盐不会有问题，或者未加工肉类中的饱和脂肪不会造成危害。

Or in other cases, people fall for that naturalistic fallacy of, well, natural salt that I'm adding can't be a problem or saturated fat isn't a problem if it's coming from unprocessed meat as an example.

现在这种方式或许能让我们开始处理某些已知过量摄入会有问题的营养成分。

Now this might be a way where we can maybe start doing something with some of these nutrient profiles that we know already can be problematic when consumed in excess.

完全正确。

Exactly right.

这并不是说超加工食品的其他方面——比如食品基质对能量密度的影响，以及这些食品常通过脱水处理来延长保质期和抑制细菌生长——可能就不存在有害因素。

And it's not to say that there might not also be something deleterious about these other aspects of ultra processed foods with respect to the food matrix and how that affects energy density and the way that these foods are often dried out and as a means of preserving their shelf life and to inhibit bacterial growth.

但与此同时，这种加工机制——即食品的物理加工过程——实际上正在以独立于食品宏量营养素组成的方式浓缩食品的热量。

But at the same time, that mechanism, that processing, that's actually the physical processing of the food is actually concentrating the calories of the food in ways that are independent of the macronutrient composition of the food.

因此我认为超加工食品还有其他方面和机制值得关注，这些因素超越了食品本身的营养成分。

And so I think that there are other aspects of ultra processing and mechanisms that you can look at that go beyond just the nutrient profile of the foods themselves.

不过我想有些营养评价体系（比如英国的体系）确实会考虑能量密度，但其他体系则没有。

Although I guess some nutritional profiling systems, The UK one, for example, does take energy density into account, others don't.

但这至少是研究这些现象的一个切入点。

But that's one way to start to look at those things.

那么或许我们可以讨论下目前已提出的那些主导机制，即便在营养成分匹配的情况下，也可能解释为何会引发过量摄入。

So maybe let's talk about some of those at least leading mechanisms that have been proposed thus far that might explain, even if we were to match nutrient profiles that there could be something that drives excess intake.

你提到了能量密度这个因素。

You mentioned one around energy density.

我们之前与Kieran Ford教授讨论过，他的实验室关于食物质地的研究可能与此相关。

Some of the work that we previously discussed with professor Kieran Ford that his lab does around food textures could play a role here.

对你而言，目前有哪些主导机制至少指明了研究方向，让我们有理由认为这些领域值得优先探索？

For you, what are some of the leading mechanisms that you think right now are at least pointing the way that these might be a good place to start, that we have at least some suggestion could be playing a role here?

是的。

Yeah.

所以我认为我们必须非常明确地针对什么机制，对吧？

So and I think we have to be very specific about mechanisms for what, right?

我们正在观察某些结果，并希望理解高含量超加工食品的饮食与该结果相关联的机制，因为针对一个结果的机制可能与另一个结果的机制大不相同。

So we're looking at some outcome and we want to understand the mechanisms by which diets high in ultra processed foods are linked to that outcome because the mechanisms for one outcome might be quite different than the mechanisms for another outcome.

在我的职业生涯中，我尤其对肥胖症及其模型感兴趣，以及为什么过去几十年在美国和许多工业化国家中肥胖症患病率有所上升。

I've been particularly interested in my career on obesity and models of obesity and why we've seen the increased prevalence of obesity occur over the past several decades in The US and around many industrialized nations.

因此，当你关注肥胖症时，就必须开始思考热量摄入、热量消耗、体内能量分配偏向体脂肪而非其他组织这类问题。

And so when you're interested in obesity, you have to start to think about calorie intake, calorie expenditure, partitioning of energy inside the body towards body fat versus other tissues, those types of questions.

所以我特别感兴趣的问题是：如果我们匹配两种食物环境中的几种关键营养素——如宏量营养素、糖、钠、纤维——并且给人们相同的热量，简单地指示他们想吃多少就吃多少，当人们不试图改变体重时，在超加工食品含量极高的饮食与根据NOVA系统基本不含超加工食品、主要是最低限度加工食品的饮食中，他们会怎么做。

And so I was particularly interested in the question of if we match two food environments for several of the nutrients of concernso macronutrients, sugar, sodium, fiberand also then gave people the same number of calories and gave them simple instruction to eat as much or as little as they want, What would people do when they're not trying to change their weight in a diet that was very high in ultra processed foods versus a diet that had no ultra processed foods, but was mostly minimally processed foods according to the NOVA system.

我们在2019年发表了那项研究，结果是人们在超加工食品环境中过度摄入热量，体重增加，体脂肪增加，而在最低限度加工饮食中体重减轻，体脂肪减少。

And we published that study back in 2019, and the upshot was that people overconsumed calories during the ultra processed food environment, gained weight, gained body fat, and lost weight and lost body fat in the minimally processed diet.

显然，尽管这些人在饥饿满足感、饱腹感和进食能力方面相同，食欲水平相似，但某些情况仍在发生。

So clearly something was happening despite these folks eating to the same degree of hunger satisfaction, fullness, and eating capacity, the same sort of appetite levels.

在超加工食品环境下，他们摄入了多出数百卡路里的热量。

They were eating many more hundreds of calories on the ultra processed food environment.

由于我们匹配了这些关键营养素总量，问题就在于两种饮食之间有何不同？

And so because we match for these overall nutrients of concern, the question was what was different between the diets?

因此我们对那项研究及另一项自由进食研究进行了事后分析，探究在特定一餐中，哪些膳食特性与热量摄入增减相关。

And so we did a post hoc analysis of that study and another of our ad libidum feeding studies to ask the question on a given meal, me, on a given meal, what were the properties of the meal that tended to be associated with increased calorie consumption versus reduced calorie consumption?

我们识别出了若干影响因素。

And we identified several factors.

正如你提到的基兰·福特（2019年论文作者之一）所指出的，人们进食速度更快——准确说是每分钟摄入克数更高。

One of them was, as you mentioned, Kieran Ford, who was an author of that 2019 paper, noted that people ate the foods quicker in terms of grams per minute, the meals, I should say.

这确实是一个关键影响因素。

And so indeed, that was one factor that played a role.

当以每分钟克数衡量进食速度时，如果给某人一盘食物且他们吃得越快，就越容易过量摄入热量。

If you put a plate of food in front of somebody and they ate the food more quickly, then they tended to over consume calories when eating rate is measured in grams per minute.

另一个重要因素是餐食的整体能量密度——即盘中固体食物的热量密集程度。

Another factor that seemed to play a role was the overall energy density of the meal, the solid foods that were presented on the plate.

原始饮食的能量密度是匹配的，但这仅在我们提供饮料的情况下才成立。

The energy densities of the original diets were matched, but that was only when you included the beverages that we gave people.

由于我们试图匹配总纤维量，最终将一些可溶性纤维稀释在饮料中。

Because we were trying to match overall fiber, we ended up diluting some soluble fiber inside beverages.

因此在超加工饮食中，餐食的整体能量密度是一致的。

And so in the ultra processed diet, and as a result, the overall energy density of the meals was consistent.

但当你去掉饮料后，餐盘上食物的非饮料能量密度明显高于超加工饮食，这确实是单餐热量摄入的主要驱动因素。

But when you remove the beverages, the non beverage energy density of the foods on the plate were quite a bit higher than the ultra processed diet, and indeed that was a major driver on an individual meal basis of calorie intake.

另一个最初让我惊讶的因素是——正如我所说——我们匹配了整体饮食中的脂肪、盐、糖和碳水化合物。

The other which was initially a surprise to me because, like I said, we matched the fat, the salt, the sugar, and the carbs of the overall diets.

堪萨斯大学教授塔拉·法齐诺在肥胖学会的一次演讲后找到我说：'我们刚制定了新的客观阈值来定义什么是超美味食物'。

Tara Fazino, who's a professor at University of Kansas, she came up to me afterwards, after a presentation at the Obesity Society, and she said, you know, we just developed this new objective thresholds for what it deems a food to be hyperpalatable.

这些是跨越预定义阈值的营养素组合：要么高脂肪高糖，要么高脂肪高盐，要么高碳水高盐。

These are pairs of nutrients that cross predefined thresholds for being either high in fat and sugar, high in fat and salt, or high in carbs and salt.

所以我最初回应：'既然我们匹配了所有这些指标，应该不会有差异'。

And so at first I said, well, we match for all those things, so it won't make a difference.

但她说，不，那盘子里单个食物的情况呢？

But she said, well, no, but what about the individual foods on the plate?

你们是否给人们提供了更多超过这些阈值的单个食物，而不是整体餐盘？

Did you present people with more individual foods that crossed those thresholds, not the overall plate?

结果发现我们确实这么做了。

And it turned out indeed that we had.

与最低加工饮食条件相比，在超加工饮食条件下，我们给人们提供了更多超过这些营养素组合阈值的单个食物。

We had presented people with more individual foods that cross these pairs of nutrient thresholds in the ultra processed diet condition as compared to the minimally processed diet condition.

这些就是所谓的超可口营养素组合。

These are the so called hyper palatable combinations of nutrients.

我说'所谓'是因为尽管被标记为超可口，但我们没有测试这些单个食物的适口性，不过整体餐食被评价为同样令人愉悦。

I say so called because despite being labeled hyperpalatable, we didn't test for palatability of those individual foods, but the overall meals people rated as being equally pleasant.

所以称它们为超可口是否用词不当暂且不论，它们只是这些特定的营养素组合。

So whether or not it's a misnomer that they're called hyperpalatable, they're just these pairs of nutrients.

这可能是改天再讨论的话题了。

So it's a topic for another day, probably.

但这也在决定人们选择摄入多少卡路里方面起到了作用。

But that also played a role in determining how many calories people chose to eat on the plate.

如果我们在餐盘中提供更多超美味食物，尽管如我所说，他们并未报告这些餐食比其他餐食更令人愉悦，但他们仍会选择摄入更多卡路里。

If we presented them with more hyperpalatable foods on the plate, then they chose to eat more calories, despite, like I said, not reporting those meals being any more pleasant than other meals.

这些就是我们发现的可能驱动这种效应的因素。

Those were the kind of things that we found that were potentially driving this effect.

当然，这很合理，你可以围绕此讲述一个引人入胜的故事，并引用文献中支持这些推论的其他数据。

And so, of course, that makes sense, and you can tell a compelling story about that, and you can point to other data in the literature that would support those inferences.

但要真正理解，你必须设计一个新实验，并在新试验中进行前瞻性测试。

But to really understand, you actually have to design a new experiment and prospectively test that in a new trial.

这个试验我们大约在2022年启动，我记得是在美国国立卫生研究院开始的，当时我们重新设计了两套新的超加工饮食方案。

And that was a trial that we started, I guess, back in 2022, I believe we started that trial at the NIH where we reformulated two new ultra processed diets.

其中一套——即原始超加工饮食方案，虽略有不同，但仍具有高能量密度和大量超美味食物。

One that was, so the original ultra processed diet, I mean, slightly different, but it also has high energy density and high numbers of hyper palatable foods.

我们重新设计的新方案具有高能量密度但减少了超美味食物的含量。

We re engineered a new one that had high energy density and low amounts of hyper palatable foods.

然后我们设计了第三种超加工食品饮食方案，其中80%的热量仍来自超加工食品，但能量密度低且低超可口性食物，类似于不含任何超加工食品的微加工饮食。

And then we had a third ultra processed diet that still had 80% of calories from ultra processed foods, but it's now in low energy density and low in hyper palatable foods, similar to the minimally processed diet that contained no ultra processed foods.

因此我在离开美国国立卫生研究院后不久就完成了这项研究。

And so we finished that study shortly after I left the NIH.

我们已开始数据分析，并在多个会议上展示初步结果，收集反馈意见，正在撰写研究报告，希望能很快提交。

We've started the data analysis and started presenting the results of that at various conferences and whatnot and getting feedback on it and writing up the results that we hope to submit very soon.

关键在于，通过同时控制非饮料类食物的能量密度和超可口性食物，我们基本能使人摄入的热量趋于正常水平。

The upshot is that by addressing both the energy density, the non beverage energy density, and hyper palatable foods, we're able to more or less normalize the number of calories people choose to eat.

即便食用超高比例的超加工食品，他们也不会再增重。

They no longer gain weight despite eating a diet that's very high in ultra processed foods.

这确实表明，通过真正理解其机制，我们现在可以针对那些可能推高整体膳食能量密度和超可口性食物数量的食品类别，从而控制膳食总能量摄入和体重增长。

And it really suggests that, you know, by actually understanding the mechanisms, now you can actually target categories of foods that might tend to drive the overall meal energy density and the number of hyperpalatable foods there, the overall energy intake of the meals and promote weight gain.

而就超加工食品这一大类而言，你仍能设计出含有大量超加工食品的饮食方案，但由于我们触及了某些根本机制，这并不必然导致热量过度摄入和体重增加。

Whereas the ultra processed foods as a category, you can still compose a diet that has a very high number of ultra processed foods in them, but that doesn't necessarily lead to over consumption of calories and weight gain because we're really getting at some of the underlying mechanisms.

这之所以重要，有几个关键原因。

And this is really important for a few reasons.

首先，这正好印证了你一开始提出的观点：如果我们能更清晰地理解这些机制并针对它们采取措施，不仅能在公共卫生领域更精准有效地调整饮食策略，还避免了——用个不太恰当的说法——‘把婴儿和洗澡水一起倒掉’，即仅凭分类就全盘否定某类食品，而实际上这种分类可能并未触及我们在高加工食品饮食中观察到的关联性问题本质。

One, it speaks to the exact point that you led off with that if we can understand these mechanisms more clearly and target those, not only are we getting a more refined ability to target diet in an effective way at public health, but we're also not going to, for lack of a better term, throw the baby out with a bathwater and say this group of foods is all gone based on this classification, which may not actually be speaking to the problem with these associations we're seeing with high UPF diets.

其次，这也让我们有空间预见性地实现你所说的场景：人们可以拥有在某种程度上仍依赖加工、但能促进健康或至少在许多方面保持中性的饮食。考虑到社会因素等长期需求，我们能想到多种理由说明这种饮食方式可能是有益的。

Then it also gives us scope to foreseeably have a situation, like you said, where people can have diets that could be health promoting or at least neutral in many ways that still rely on processing to some degree, which we can think of a variety of reasons why that might be beneficial, over a long period of time for societal reasons and beyond.

因此我们正在推动的这些重要事项将直接影响政策制定。

And so we have these really important things going on that would impact policy.

此外，我认为这还回应了包括我在内许多人的一个不满：关于超加工食品与负面结果的因果关系，有时‘因果’这个词被过于随意地使用。

And also I think it speaks to one of the pet peeves of many people, including myself, is how loosely sometimes the word causal is being thrown around in regards to ultra processed foods and any of these negative outcomes.

没错。

Right.

同理，这并不意味着当你没有谨慎控制这些特定机制因素（至少是我们认为决定热量摄入的机制因素）时，就可以完全忽视超加工食品类别——因为它们往往具有更高的能量密度，且更多产品会突破这些营养阈值组合。

And in the same way, it doesn't say that when you aren't careful to manipulate these particular mechanistic factors, at least the things that we believe are mechanistic in terms of determining somebody's calorie intake, it doesn't mean that you can just ignore the ultra processed food category entirely even for that, because they tend to be higher in energy density and they tend to have greater numbers of products that cross these pairs of nutrient thresholds.

正如基兰·福特提到的，这类食品往往也更容易被快速食用。

They also tend to be foods like Kieran Ford has mentioned that are tend to be more quickly eaten.

我们新研究中有个有趣发现：与旧研究不同，实际进餐速度在不同组别间基本是一致的。

And that's another point that was kind of interesting in our study, the new one, unlike the old one, the actual meals were eaten more or less at the same rate.

所以以每分钟克数计算，这次我们实际上没有发现整体上的差异。

So in grams per minute, we actually didn't see differences this time across the board.

无论是微加工食品、超加工食品、高能量密度食品，还是高适口性食品，甚至其他新配方的版本，进食速度都相同。

So minimally processed, ultra processed, high in energy density, high in hyper palatal foods, then the other new reformulated versions were eaten at equal rates.

然而我们却观察到巨大波动——微加工食品与高能量密度且高适口性的超加工食品之间，每日热量摄入差异近千卡路里。

And yet we had huge swings like almost a thousand calorie a day swing between the minimally processed and the ultra processed that was high in both energy density and hyper palatable foods.

而回归到类似微加工饮食时，每日仅相差约100卡路里，与高比例超加工但低能量密度、低适口性的饮食相比，这种差异在统计学上并不显著。

And then all the way back down to something like the minimally processed diet, only a 100 or so calories a day different, not statistically significant with the high ultra processed, but low in energy density, low in hyperpalatable foods.

所有类别的食物在每分钟克数进食速率上都保持一致。

Across the board, they were eaten at the same rate in terms of grams per minute.

这并不意味着进食速率不起作用，但在进食速率恒定的情况下，显然其他因素起着更重要的作用——这是我们研究中一个有趣的发现。

Doesn't mean that eating rate can't also play a role, but it seems that certainly these other factors are playing a large role in the context of a constant eating rate, which was kind of interesting in our study.

因此这并不排除：当你设计高比例超加工食品的饮食时，往往会重现我们首次研究中的结果——人们进食速度更快，这是个附加影响因素。

So it doesn't again rule out the fact that many times when you compose diets that are high in ultra processed foods, you will have the results that we found in the first study, which is that people also eat them more quickly, which is an additional factor.

所以作为指导原则：即便识别出机制，也不意味着可以完全抛弃超加工食品这个概念作为参考标准。

So as a rubric of saying, once you identify the mechanisms, it doesn't mean that you can throw out the concept of ultra processed food as a guide.

这意味着实际上你需要付出更多努力，因为事实证明，高含超加工食品的饮食往往会驱动许多这些相同的机制性因素。

It means you actually have to work a lot harder because it turns out that diets that are high in ultra processed foods tend to drive many of these same many of these same more mechanistic factors.

除非你愿意逐一检查并确认：好吧，我现在设计的这种饮食对人们来说并不容易，对吧？

And unless you're willing to go and look at each individual one and say, Okay, well, is this diet that I've now composed, which is not easy for people, right?

这并不明确，进食速度会如何变化尚不清楚。

This isn't, it's not, it's clearly, it's not clear what eating rate is going to be.

你整餐的能量密度会是多少也不明确。

It's not clear what the energy density of your overall meal is going to be.

通过一些计算可能稍微清楚某些食物是否跨越这些营养阈值，但没人会真的坐下来用计算器推算。所以在某种意义上，超加工食品的整体分类标准仍然重要，但现在我们可以开始瞄准真正有问题的机制。

It might be a little bit more clear with a few calculations what the whether or not a given food crosses these pairs of nutrient thresholds, but no one's going to be sitting down with their calculator to kind of figure So that in some sense, the overall rubric of ultra processed foods is still an important one, but now we can start to target what are the real problematic mechanisms.

这最终成为人们争论的另一个焦点：即使我们深入这些机制，使用NOVA分类法仍有很强实用性——作为启发式工具，它通常能提供大量信息，尤其对人们做实际决策很有帮助，在这方面可能具有实际价值。

This ends up being another debate that people have is that utility of using the NOVA classification that even if we do get down to these mechanisms, you could still make a pretty strong case that as a heuristic, generally it gives us a lot of information, particularly for people to make practical decisions, and it might have some real utility there.

也有其他人持更强硬立场，认为即便从这个角度看，它仍会误导我们，提供的精确度不足，我们需要完全不同的分类体系——这些分歧会引发更多争论。

There are also other people in that maybe take a stronger stance and say, well, even in that sense, it's still leading us astray and it doesn't give us enough precision and we just need to have a different classification altogether and you end up getting more of these different debates.

但至少我们掌握的数据越多，就能在这些争议点上进行更知情的讨论。

But the more data we have, at least we can have more informed discussion in those debate points, I guess.

我认为书中试图探讨的一个有用观点，也是我近期演讲中一直强调的，就是引入‘健康超加工食品’的概念——因为这未必是个矛盾修辞。

I think a useful thing that we try to get at in the book and that I've been trying to get at in some of the talks that I've given recently is to introduce the concept of a healthy ultra processed food because it's not necessarily an oxymoron.

超加工食品的定义本身并不必然意味着它们对健康有害。

There is nothing in the definition of ultra processed foods that means that they have negative health consequences.

所以我觉得人们会直接得出这个结论，是因为这个名称和类别听起来很吓人。

So that's, I think, again, something that people jump to that conclusion because it's a scary sounding name and scary sounding category.

或许这个分类最初的目的是识别饮食中起负面作用的成分，但这其实是个实证问题。

And I think maybe the original intent of the category was to identify the things that were playing a bad role in diet, but that's an empirical question.

这并不属于定义本身的组成部分。

That's not part of the definition itself.

事实证明，确实存在这些关联性。

And it turns out, yes, there are these associations.

但我们可以反过来提问：不存在健康的超加工食品并不是定义层面的问题。

But I think we can push back and ask the question, it's not a definitional issue to not have a healthy ultra processed food.

是否存在可能制造出健康的超加工食品？

Is it possible to have a healthy ultra processed food?

那会是什么样子？

What would that look like?

我认为这正是可以引入更传统的营养评价体系的地方，我们可以说：好吧，如果它因为含有多种添加剂或防腐剂等成分而被归类为超加工食品，但同时富含全谷物、蔬菜、豆类，且低钠、低饱和脂肪。

And I think that that's again where you can bring in the more traditional nutritional profiling systems that we've had to say, Okay, well, if it's ultra processed because it contains several additives or preservatives or something like that, but it's also high in whole grains, high in vegetables, high in legumes, low in sodium, low in saturated fat.

确实，它可能包含多种食品技术成分，使得这类食物更便于食用，而且很可能比营养贫乏的同类产品更昂贵。

And yeah, sure, it might contain several kind of pieces of food technology so that it makes it convenient to eat that kind of food and probably is more expensive than the nutritionally poor counterpart.

但这算是对人们健康有益的选择吗？

But is that a healthy option for people?

我认为如果它具有优良的营养成分，符合通常被归类为健康食品的标准，并且之所以被认定为超加工食品，并非因为营养评价角度下的有害成分、能量密度过高或营养素组合过度诱人，而是由于用于大规模生产这类食品的某些食品技术——我敢大胆推测，这种食品极有可能属于健康的超加工食品。

And I think that we could probably say if it has a good nutritional profile and meets what would normally be categorized as a healthy food from that perspective, and is ultra processed because of probably not the bad guys from a nutritional profiling perspective or energy density or hyper palatable combinations of nutrients, but because of some of the food technology that's used to mass produce these kinds of foods, I'm going go out on a limb and say that's got a high chance of being a healthy ultra processed food.

我们越是能激励这类食品的研发，并通过研究实际验证其健康性（而非想当然认为它们一定健康），就越有可能为重新定义这个场景开辟道路：并非该类别下的所有食品都是有害的。

And the more that we can incentivize those kinds of foods and actually test them in studies to not just take it for granted that that's going to be healthy, that that's probably the path forward to think about reframing the scenario of not every food in this category is bad.

很可能存在对健康中性的一个子类别。

There's probably a group that are neutral for health.

显然也存在应被视为娱乐性物质和零食的类别，仅供偶尔食用。

There's clearly the group that should be treated as recreational substances and treats and only for rare use.

那么可能还存在一类食品，它们对我们而言是潜在健康的，能减轻工作负担并提升这类饮食变革的便利性。

And then there's probably a category which are potentially healthy for us and would reduce the workload and increase the convenience of these kinds of positive changes to people's diets.

我们应当考虑推广这类食品并确保其安全性，将其作为前进方向，不仅通过惩罚性税收等政策来减少公认的有害食品，更要提升那些便捷替代品的地位——若能更普及且价格更低，这些替代品很可能改善大多数人的饮食质量。

We should be thinking about promoting those kinds of foods and testing them to make sure that they're safe, but promoting those kinds of foods as a path forward, not just dealing with punitive taxes and other policies to reduce what most people agree are the bad guys, but also lifting up the convenient alternatives that will likely improve the quality of most people's diets if they were more widely available and and less expensive.

我认为接受这一观点至关重要，因为它为我们敞开了拥有这些潜在选择的大门。

And I suppose acceptance of that point is really important as well because it opens us up to have those potential options.

因为我甚至见过像配方改良这样的举措在某些圈子被完全否定，只因它可能涉及与食品工业的合作。

Because I've seen even things like reformulation get completely rejected from some circles because it maybe lends itself to playing a role with the food industry.

我们仍在审视加工食品，实际上应该引导人们选择最低限度加工的食品。

And we're still looking at processed foods and really we need to be pushing people towards minimally processed foods.

但再次强调，不能忽视一个事实：我们没理由不能拥有高度加工却对整体健康有益的食物，而非简单地将所有加工食品等同于负面。

But again, negating the fact that there shouldn't be a reason why we couldn't have a highly processed food that could play a beneficial role in our overall health as opposed to saying anything processed equals negative.

没错。

Right.

我与许多人有过这样的对话，特别是在拉丁美洲——那里尚未被超加工食品完全占领食品体系，其超加工食品热量占比约20%，而美国和英国则高达50%或60%。

And I've had this conversation with many folks, especially coming from Latin America where they haven't already had the takeover of ultra processed foods from their of their food system, and they're hovering in that 20 of calories from ultra processed foods as opposed to something more like 60 or 50% in The US and The UK.

我认为可以合理地说，我们确实需要尽量减少超加工食品对我们传统饮食方式的侵蚀，并在那些尚未被超加工食品占领的国家推广轻度加工的饮食。

And I think it's a reasonable thing to say, to say, okay, we really do just want to minimize ultra processed food, the takeover of our sort of traditional food ways, and we want to promote the minimally processed diets in those countries that haven't already seen the takeover.

我认为这样做是完全合理的，既能保护他们的文化，也能兼顾其他因素。

And I think that's a perfectly legitimate thing to do and to kind of protect their culture and other factors.

但我觉得不合理的是，对像美国、加拿大和英国这样的国家说：你们已经经历了食品供应中超加工食品的激增。

What I think is not a legitimate thing to do is to take countries like The US and Canada and The UK and say, you guys have already experienced this incredible rise in ultra processed foods in your food supply.

你们真的打算倒退回去，减少超加工食品的数量吗？

Are you really going to go backwards and reduce the number of ultra processed foods?

还是说你们会尝试调整现有的超加工食品环境，使其更健康？

Or are you just going to try to adapt the ultra processed food environment that you already have towards a more healthy one?

我倾向于认为后者是更明智的路径。

I tend to think that that's the more sensible path.

我喜欢这样比喻：就像我们经历了高油耗汽车的全面普及——这在美国确实是事实，对吧？

The way I sort of like to say it is it's kind of like we've experienced the takeover and literally this is true in The US, the takeover of the gas guzzling automobile, right?

我们建立了基础设施，创造了让大多数美国人依赖汽车的整个体系。

I mean, we created the infrastructure, we created all of this way that most of The US is dependent on automobiles.

我想一种做法可能是说，不，我们必须回到马车时代，对吧？

I guess one path would be to say, no, we got to go back to the horse and buggy, right?

这才是前进的方向。

That's the path forward.

但答案其实是，我们必须利用现有技术改善公共交通，使其更便捷高效地为人们服务。

But no, the answer is we've got to use the technology that we have to improve mass transit and make it more readily available and efficient for people.

我们必须制造更好的电动汽车，并建设更完善的电网。

We've got to build better cars that are electric and have a better electric grid.

我们必须利用现有技术向前迈进，而不是追溯过去，仿佛过去必然是我们都想回归的乌托邦。

And we've got to use the technology that we have to move forward, not to retrace the past as if the past was necessarily some utopia that we all want to look back on.

我们祖母和曾祖母时代的饮食很可能营养不全面，而且需要家庭成员中有人每天花费大量时间为大家做饭。

The diets of our grandmothers and great grandmothers were probably not nutritionally complete and involved one member of the family basically cooking meals for the rest of the family spending hours and hours a day doing that.

这并不是我们很多人想象中那种过去少加工食品环境的乌托邦景象。

That's not the utopia that I think many of us like to picture when we think of a minimally processed food environment of the past.

没错。

Right.

我总体上确实不是食品工业的拥趸，我们可以指出许多对食品环境产生负面影响的方面，这些我们稍后会讨论到。

I'm certainly no fan of the food industry generally in terms of there's certainly things we could point to that are negative in terms of influencing our food environment, which we'll we'll get to.

但完全拒绝与之合作或不给他们任何改进的途径，可能并非最佳策略。

But to say that any rejection of that or giving them no path forward to be worked with might not be the the best strategy.

刚才你提到，如果我们从可能影响公共健康的监管或政策角度审视，主要的调控手段包括激励提供更优质的食品，同时抑制对健康有害的食品或饮食方式的消费。

A moment ago, you mentioned that if we are looking at this from a perspective of regulation or policy that may influence public health, some of those primary levers to pull on would be incentivizing better quality foods that might be available and then disincentivizing consumption of foods or diets that would be negative towards health.

能否请你谈谈对此的看法，以及有哪些证据表明这是一条积极的推进路径，通过这种激励方式能获得哪些益处？

Can you maybe talk a bit about your perspective on that and maybe some of the evidence that would suggest to us that is a positive route forward, that there is benefit to be gained by looking at incentives in this way?

是的。

Yeah.

这对我来说是个有趣的话题，因为在NIH工作时，这是被禁止讨论的内容——我们在NIH不应该谈论政策。

So this is a fun topic for me to talk about because when I was at the NIH, was a topic that I was not allowed to talk about because we're not supposed to talk about policy at the NIH.

我们只讨论科学。

It's only science that we talk about.

所以撰写书中这一章、研究美国食品监管政策的历史，实际上非常有趣。

So it was actually a lot of fun writing this chapter of our book and looking at some of the history behind food regulation and policy in The US.

我认为现在人们非常强调要识别出那些我们需要减少或避免摄入的食物和成分。

I think that there's a lot of emphasis these days on identifying the foods and the ingredients that we want to eliminate or reduce consumption of.

但却很少讨论如何推广那些真正能促进大众健康的食物和整体饮食模式。

And there's not a lot of discussion about promoting foods and overall dietary patterns that will actually facilitate better health for many people.

而这可以一直追溯到农业系统本身，对吧？

And that goes all the way back to the agricultural system, right?

我的意思是，如果明天全美国人醒来后都能按照《美国居民膳食指南》进食，每个人都摄入推荐量的果蔬，那我们就会陷入大麻烦——因为我们根本种不出那么多这类食物来满足需求。

I mean, if everybody in America tomorrow woke up and were actually able to eat according to the dietary guidelines for Americans and were basically said we're going to eat the amount of fruits and vegetables that are recommended for everybody in America, we'd be in a whole lot of hurt because we don't grow nearly enough of those kinds of foods to do that.

所以无论我们提出多少饮食建议，这并不必然转化为实际行动，更无法保证这类饮食模式的可得性和易行性。

So no matter how much recommendations we have, that doesn't necessarily translate to action and that certainly doesn't translate to availability and ease of being able to adopt those types of patterns.

因此可以考虑税收补贴等激励措施，比如针对超市的税收优惠政策。

And so you can look at things like tax subsidies and tax incentives to, for example, the supermarket.

美国的超市处于一个关键杠杆点。

The supermarket in The US has is at a leverage point.

这是我们大多数人获取日常所需大部分卡路里的场所，而从营养学角度评估，超市销售的产品——根据美国农业部一项研究显示，用健康饮食指数衡量时，普通购物篮的营养状况简直惨不忍睹。

It's where most of us experience most of the calories that we end up eating, and the products that are being sold in supermarkets from just a nutritional profiling perspective, the average grocery basket, when you look at the healthy eating index, a USDA study showed that it was pitiful.

这个健康饮食指数简直低得可怜。

It was like a really poor healthy eating index.

我们可以为超市提供税收优惠——例如，如果他们的购物篮平均销售额达到健康饮食指数的特定阈值，就能减轻税负。

We could offer supermarkets tax incentives that would reduce their tax burden if the average sales of their of their grocery baskets reached certain thresholds for the healthy eating index, for example.

这将促使制造商生产更多此类产品，同时抑制超市宣传那些会拉低购物篮平均健康饮食指数的商品。

That would put upwards pressure on manufacturers to provide more of those kinds of products, and then would disincentivize the supermarket from advertising the kinds of products that would lower the healthy eating index of their average grocery basket.

实际上可以对超市实施阶梯税率制度，对吧？

In fact, you could tax supermarkets for you could have a sliding scale, right?

超市的税率将与其顾客购物篮的平均健康饮食指数直接挂钩。

Your tax is basically in proportion to the average, the average healthy eating index of a supermarket purchase.

同理，食品制造商目前可以把所有食品的研发和营销费用进行税务抵扣。

Similarly, food manufacturers right now can they can write off the research and development and marketing of all of their food products.

这对他们来说是合法避税手段。

Can that's a tax write off for them.

但我们可以规定：只有那些达到特定营养标准的食品，其开发和营销费用才能享受税务抵扣。

Well, you could say you can only get that tax write off if you're the food that you're using that's developed and marketed reaches certain nutritional profiling standards.

如果某种食品符合健康标准，比如美国农业部的健康定义，那么或许可以获得这项税收减免。

If it's a healthy food according to, for example, the USDA definition of healthy, then maybe you can get that write off.

但如果不符合该定义，就无法再享受这项减免。

But if it doesn't meet that definition, you no longer get that write off.

实际上必须全额承担这些新产品的营销和开发成本。

You actually have to pay the full cost of marketing and developing those new products.

这将激励制造商生产更多健康版本的产品，并可能使其与不健康版本的产品具有市场竞争力。

And that's an economic incentive for manufacturers to produce more of the healthier versions of those products and potentially be able to make them competitive with the less healthy versions of those products.

可以实施各种巧妙的政策措施。

There's all sorts of clever policy things that one could do.

以上只是两个例子。

Those are just two examples.

但关键在于，不能仅仅专注于减少最有害产品的可获得性和提高其价格。

But I think the point is that you can't just focus on reducing availability and increasing the price of the potentially worst offenders.

当然，这方面的工作也必须推进。

That should be done, definitely.

这些措施，以及我们在公共卫生领域运用烟草管控手册中的所有策略，都需要针对这类问题实施。

Those, and using all the things that we did with the tobacco playbook in public health needs to be done for those kinds of things.

但与烟草不同——人们没有消费烟草的需求，食物却是必需品。

But unlike tobacco, where there's no requirement for people to consume tobacco, there is a requirement for food.

与此同时，我们需要推动更健康食品的研发和销售。

And what we need to do simultaneously is promote the development and sale of healthier products.

我认为你刚才提出的观点非常重要，这关联到我最近与艾米丽·卡拉汉合作的一期节目内容。

I think you you made a really important point there that related to one of our previous episodes that I recently did with Emily Callahan.

正如她谈到的政策理念：人们常有的误解（有时可能是刻意用来弱化政策作用的论调）就是声称'看吧，就算实施这项政策也收效甚微'。

As she spoke this idea around policy that one of those misconceptions that some people have or sometimes is maybe purposely used to downplay the potential role of policy is showing, oh, well, look, if we put in this policy, it's not going to have much of an effect.

这种观点完全没抓住重点——没有任何单项政策能单独改变慢性病风险或肥胖这样复杂的健康问题。

And that's kind of missing the point in that no one individual policy here can ever be expected to make changes as something as big as chronic disease risk or obesity.

真正的解决之道在于全面审视这些问题，看我们能否协调实施多项政策，通过长期合力产生实质性的影响——这本质上就是你所强调的核心。

What really is is looking at all these problems and can we put in a concert of these policies that taken together will have meaningful impact over the long term, which is essentially the point you're looking at.

我们该如何通过一系列协同运作的政策，重新设计或改变食品供应体系、食品系统以及人们与食物的互动方式，而不是天真地认为只要对某种营养成分征税就能万事大吉。

How can we redesign or change elements of the food supply, the food system, how people interact with that all through a set of policies that are working in concert as opposed to if we just tax this one particular nutrient, then everything is going to be okay.

对。

Right.

没错。

Right.

不，这实际上完全正确。

No, that's actually absolutely true.

事实上，这正是我们在研究中发现的——即便是政策最激进的国家，比如那些在食品包装上贴大幅黑色警示标签、征税并试图将某些有害超加工食品清除出校园体系的拉丁美洲国家，当你回过头去看这些政策对健康结果的实际影响时。

In fact, that's one of the things that even when we did a little bit of research on how even the most aggressive nations in terms of policies, so typically the Latin American nations that have put the big black warning labels and have taxed and tried to eliminate certain harmful ultra processed foods from their school system, for example, And you go back and you look at what are the health outcomes of those.

这些政策已实施多年，似乎确实减少了这类食品的销量。

Those have been in place for several years now, and they have seemed to reduce the sales of those kinds of foods.

但对健康有哪些积极影响呢？

But what are the positive effects on health?

目前还不多见。

And they're just not that many yet.

我认为唯一能明确报告的是龋齿率下降，这倒是件好事。

I think the one they can actually report is a reduction in dental caries, which is a good thing.

我并不是说这不是好事，但我觉得政策制定者不应过度承诺，声称这将解决肥胖问题，就像你刚才说的那样。

I'm not saying that's not a good But I think it's also important for policymakers to not overpromise and say that this is going to solve the obesity epidemic, kind of like you were saying.

这需要一系列措施共同作用。

It's going to be a suite of things.

这些政策变化能在多大程度上带来公共卫生的全面改善，仅依赖一项或少数几项措施可能远远不够。

And to what extent these policy changes are going to have sweeping changes in public health, relying on any one or even a handful is potentially not going to be enough.

因此我们不仅要考虑政策层面，还要激励食品公司生产更健康的食品，并通过政策让这些食品更便宜、更易获取。

And so we have to think about not just the policy piece, but also incentivizing food companies to produce the healthier foods that and give them the incentives to make those cheaper for people and more widely accessible.

比如我们在书中提到的另一个例子：美国的营养援助计划不允许使用预制食品。

So for example, another thing that we talk about in the book is that the program that provides nutritional assistance to people in The US doesn't allow pre prepared foods to be used in that system.

这就限制了援助效果——想象一下联邦和州政府用于营养援助的拨款，

And so that limits the ability, you could imagine that the federal dollars and the state dollars that are being used to support nutritional assistance to people.

对于连烤箱或炉灶都没有的人来说，一箱生鲜果蔬未必有用，但即食餐就有意义，对吧？

Well, know, a box of fruits and vegetables for people who don't even have an oven or a stovetop is not necessarily going to be beneficial to them, but a prepared meal would be, right?

我的意思是，这种食物可以直接食用。

I mean, it's immediately available for being eaten.

如果它符合某些营养标准，我认为没有理由不去激励这类事物。

And if it met certain nutritional standards, I see no reason why you wouldn't want to incentivize those kinds of things.

再次强调，这更多是从积极层面着手，让健康食品更普及、更便利、更廉价，从而真正促进更优质的饮食，而不是仅仅关注标签、税收和限制有害食品的政策——后者正是过去政策的主要着力点。

And again, that's working more on the positive end of things, making the healthier foods more widely available and convenient and inexpensive to really help promote better quality diets, as opposed to focusing solely on kind of labels and taxation and policies to minimize the harmful players, which I think where is where most of the of the policy efforts have been in the past.

我想这与您刚才提出的另一个观点有关联。

And I suppose it connects to another idea that you've just raised.

您在书中还提到，我们或许可以针对某些营养素或食品成分采取措施，但若完全脱离社会经济背景来考虑这个问题是毫无意义的——正如您暗示的那样，不仅在健康方面，甚至在人们饮食结构的差异上，最大的不平等往往可追溯至社会经济因素。

You also speak about in the book that we can maybe target these certain nutrients or something to do with the food, whereas really trying to take that divorce from the context of socioeconomics makes no sense because as you've alluded to, some of these biggest disparities as it relates to not only health but even how people's diets get made up, generally gets traced back to socioeconomics.

因此你会看到食物荒漠的影响、人们获取食物的可能性、甚至购买决策等，都根植于此。

And you can therefore see the impact of food deserts or people's availability of food or even decisions around what to buy all kind of can stem back to this.

我记得之前播客中，Martin Carragher举过一个英国案例，与您所述高度相似：许多情况下，人们生活在食物贫困中，实际上最理性的选择反而是购买预制包装食品——因为如果他们购买新鲜食材，可能连烤箱都因使用成本太高而无法启用。

And I remember previous on the podcast, Martin Carragher gave a UK example that was similar to what you've just said of a lot of cases, you have people living in food poverty, and actually the rational best thing to do would be to buy something that is prepackaged, ready to consume because if they buy fresh food, they they can't use that oven because it's too costly.

所以必须结合这些社会经济背景来思考对策，制定政策时避免因政策结果对低收入群体造成不成比例的负面影响。

And so trying to think of this in the context of those socioeconomics and what can be done and put in place policies that aren't gonna disproportionately negatively affect people in lower income communities as an example by a result of this.

我们如何确保他们仍能从任何实施的政策中受益？

How can we make sure that they are still gonna be able to get the benefit of any policy that does get put in place.

完全正确。

Exactly right.

我偶然间产生了这些想法，特别是在预制食品方面——几年前我参观了谷歌总部，他们基本上为员工提供免费食物。

I sort of stumbled into these thoughts, especially in the prepared food way, by visiting, I visited Google's main campus a couple years ago, and they basically offer free food to their employees.

而且那些食物令人惊叹。

And the food is incredible.

我的意思是，他们确实非常注重确保提供营养极其丰富的饮食模式。

I mean, it's just they really focus on making sure that it's a nutritionally, really wonderful dietary pattern.

但当你问高管们为何这样做时，他们会说这是为了让人们共进餐食，促进工作场所的互动——但其实用披萨和啤酒也能达到同样效果。

But you ask the executives why they chose to do this, they talk about getting people together over meals and promoting, like, that sort of interaction in the workplace, but they could have achieved that with pizza and beer.

对吧？

Right?

他们本不需要提供这么高质量的食物。

They did not need to have this this high quality food.

但这确实让我意识到：这就是硅谷的福利。

But it really just struck me of that's a Silicon Valley perk.

对吧？

Right?

如果能让联邦和州的税收用于营养援助项目，支持在服务不足的社区开设健康餐厅，让几乎所有人都能随时光顾，并利用这些补贴资金定期为人们提供健康餐食呢？

And what if you made it so that federal tax dollars and state tax dollars that go to support nutritional assistance made it available for people to have a healthy restaurant that almost anyone could go to anytime in these underserved neighborhoods and could use those subsidized dollars to get these healthy foods prepared for them on a regular basis.

我是说，这不算什么特权，对吧？

I mean, is not, you know, a perk, right?

这应该是我们所有人共享的健康生活方式。

It's supposed to be commonality for all of us to live a healthy life.

我在想，谷歌选择这类食物而非披萨和啤酒，部分原因是否在于他们需要为员工支付部分保险费，而这些健康饮食可能有助于改善员工健康并降低保险费用。

And, I wonder if part of the reason why Google chose those types of foods as opposed to pizza and beer is because they have to pay some of the insurance premiums for their employees, and it might be potentially improving their health and lowering their insurance premiums.

这也是我们作为国家时常面临的问题，尤其是对于那些没有医疗保险的弱势群体，

And that's a topic that we face as nations all the time with our underprivileged folks who don't have health insurance,

比如在美国。

for example, in The US.

嗯，这确实开辟了一个全新的讨论领域。因为你提出的这些政策如果实施得当，，我认为会有很好的效果。

And, well, that opens up a whole other area of really trying to make a case for it because a number of these policies that you've suggested, I think it's safe to say there's a good amount of evidence to suggest that if implemented properly, they would have a a beneficial effect.

我们可以建立模型来验证这一点。

We could model that out.

在其他已经实施的案例中，我们确实能看到一定程度的成效。

There's other examples where they have been implemented where we could see some degree of benefit.

正如常见的情况，政治意愿往往在实际变革中扮演最关键的角色。

As is often the case, political will plays maybe the biggest role in actually are we gonna see some of these changes.

而论证其在降低医疗成本方面的潜在作用，往往会成为关键突破口。

And making the case for a potential role then reducing health care costs tends to be the breaking point.

如果我们能在这方面提出足够有力的论据

If we can make a strong enough case on that

没错。

Right.

那么我们就有很大机会推动这项政策通过。

Then we have a good chance of getting this through.

否则，它很可能会在各种关于监管程度的意识形态争论中被搁置。

Otherwise, it's gonna gonna fall at the wayside of ideology for one reason or the other around how much regulation we have.