Kate Smith, MD, MPH
Executive Director, Delaware Academy of Medicine
Friday, May 23, 2025 — Yesterday, the White House released it’s long-awaited “MAHA Report,” outlining the government’s target areas for addressing childhood chronic disease. This 68-page report, prepared by the Make America Healthy Again (MAHA) Commission, and chaired by Department of Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr., was ordered by President Trump in February. The report serves as an initial assessment for the commission, which now has 82 days to develop a strategy document for realigning federal practices to address the highlighted factors.
“Today’s children are the sickest generation in American history in terms of chronic disease and these preventable trends continue to worsen each year, posing a threat to our nation’s health, economy, and military readiness.”
Summary
The report notes that more than 1 in 5 children over 6 years of age in the U.S. are obese, that diabetes prevalence is increasing in youth, that autism spectrum disorder (ASD) prevalence has increased since the 1980s, as have rates in childhood cancer. It then suggests four potential drivers behind the rise in childhood chronic disease:
- Poor Diet
- Environmental Chemicals
- Lack of Physical Activity and Chronic Stress
- Overmedicalization
Overall, these issues might see common sense – most public health officials would agree with these being an issue. But let’s look deeper.
Poor Diet
The report indicates that most children’s diets are “dominated by ultra-processed foods” (UPFs). The Dietary Guidelines committee avoided making a strong recommendation on UPFs. The report included food additives (e.g., emulsifiers, binders, preservatives), specifically calling out food colorings and artificial sweeteners, among others. The science on whether certain foods harm health, and how they might lead to poor outcomes, is complex and incredibly underfunded.
While we in the public health sphere know that a diet rich in fresh fruits and vegetables and whole grains can prevent a bevy of chronic disease, the report does not mention the social determinants of disease that may account for these diets. It does not mention food deserts (wherein children do not have access to anything other than UPFs), or the cost of fresh food vs. the hyperpalatable and cheap UPFs. It does suggest that the Supplemental Nutrition Assistance Program (SNAP), the School Breakfast Program and National School Lunch Program (NSLP), and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), programs put in place to ensure that those who cannot afford food can eat, and are meant to be safety net programs for the millions of people who are food insecure in the country, may have “drifted from their original goals.”
Environmental Chemicals
The report notes that children are exposed to “thousands of synthetic chemicals” via food, water, and air, and that these chemicals may pose risks to their long-term health. Among those chemicals, the report lists heavy metals (lead and mercury), air pollutants, pesticides, endocrine-disrupting chemicals, waterborne contaminants (including fluoride), industrial residues, persistent organic pollutants, and physical agents (like EMR and microplastics). It also notes that children are vulnerable to chemicals during stages of development, and that cumulative loads may be driving higher rates of chronic disease, and that babies have “detoxification challenges.” The report also cites a report finding exposure to fluoride above recommended levels showed a “statistically significant association” with reduced IQ levels in children. (Please note that the American Dental Association has responded to these claims.)
A lot of these claims require further research. The Trump Administration is also eliminating the programs studying those risks, clawing back funding from the Environmental Protection Agency and Public Health departments (whose job it is to monitor those very issues and make recommendations).
Technology and Lack of Physical Activity and Chronic Stress
The report notes that American children have become more sedentary, and lead a more technology-lifestyle than previous generations. It suggests that this lifestyle is a contributor to declines in physical and mental health, due to increased screen time, reduced physical activity, loneliness, chronic stress, and sleep deprivation.
These numbers are absolutely true, but the report does not mention the need for a universal healthcare system, so that children may receive yearly check-ups, advice from health care providers about nutrition and physical activity. It does not mention that several programs aimed at promoting child and teen mental health have been cut from the federal budget, that the suicide hotline has been shut down. It does not mention active shooter drills, or the number of school shootings we see in the US every year.
Overmedicalization
The report states that the health system has responded to increases in childhood chronic disease with “increasing rates of pharmaceutical drug prescrptions” which “may cause further harm to the health of American children when used inappropriately.” These pharmaceutical efforts include statements about the increase in stimulant prescrptions for ADHD, an increase in antidepressant prescription rates in teens, an increase in antipsychotic prescrptions, and an over-prescription of “unnecessary” antibiotics in childhood. Among the medical procedures that are “overused,” the report includes adenotonsillectomy for children with sleep apnea; tympanostomy tubes for recurrent ear infections; the “disproportionate diagnosis” of ADHD, depression, and “intellectual disability”; an “overprescription” of athma medication for “mild” cases; and child chemical and surgical mutilation (e.g., puberty blockers, hormones, and surgeries). It also notes the “Growth of the Childhood Vaccination Schedule,” and that vaccines are not tested via placebo (which is absolutely not true).
Many of the statements in this part of the report are inaccurate or misleading. Things like “the AMA and AAP recommend these medications and procedures, however, despite an HHS review finding no long-term evidence for safety (or effectiveness) and short-term evidence of ‘very low quality'” (when referring to puberty blockers); or “blood tests for inflammation in infants with fever routinely led to a cascade of unnecessary, invasive, and harmful further testing such as spinal taps–but were broadly recommended by professional society guidelines.” The report fails to mention that, although the number of recommended vaccines on the CDC childhood vaccine schedule has increased, vaccines today are more efficient and contain fewer stimulants to the immune system; that while original vaccines are trialed with a placebo arm, updates to those vaccines are trialed against the previous vaccine; and that the procedures in place to catch lesser known side effects of vaccines (VAERS and the Safety Data Link) are actually quite effective at finding that information.
Final Thoughts
One line in particular, “Peer review, the gatekeeping attribute that defines medical journals, is ineffective and biased; reviewers at top journals are untrained, ineffective when tested, and many have financial ties to drug companies,” stood out in this report. Peer review is the gold standard of science. It asks the researcher why they chose to test their hypothesis in a certain way, what limitations might have occurred (by accident or design), and allow a bevy of the authors’ fellow researchers to weigh in on whether a study adds to the science, or detracts from it, and why.
The report contains hundreds of references, but many of them are in fringe journals, and some are extremely outdated and have been otherwise debunked by newer studies. The 2016 study (cited many times) about the overuse of antibiotics is almost 15 years old. We have made great strides in antibiotic stewardship in the ensuing years.
Nothing in this report mentions the consumption of alcohol or tobacco (yes, it is focused on children, but teenagers are children, and have been known to consume these products) and their relation to chronic disease. It paints pharmaceutical research as unsafe and biased, and indicates that a majority of researchers, clinical departments, and teaching hospitals are “funded directly by the pharmaceutical industry.” It states that societies like the AMA “discourages practitioners from conducting or discussing nuanced risk-benefit analyses that deviate from official guidelines.”
The portions of this report that deal with vaccines emphasize safety, but don’t articulate that vaccines today are the safest they have ever been. Nor does the report mention the incredible public health success of vaccines, which have saved hundreds of thousands of lives in the US, and millions of lives globally.
There is a lot in this report to upack. Children are suffering from an increased burden of chronic disease, there is a mental health crisis, and we are seeing a decrease in physical activity among this population (and in adults, too). The question remains what will come of this report. We will definitely be keeping our eyes open.