Scarlett Saitta
Jonesboro, Arkansas, United States

I first began to question the US food system when my friend’s father died of a heart attack in his late thirties. A few days after the funeral, my friend’s mother kindly served us boxed mac and cheese stamped “low sugar.” She was grieving, overwhelmed, and trying her best to serve us something she sincerely believed was healthy. Yet the boxed meal was packed with sodium. No one had told her otherwise—and she, too, was afraid of dying young and leaving her son an orphan.

I grew up in Pickens, South Carolina—a small Appalachian town where health was often explained by genetics with the shorthand “it runs in the family” rather than by nutrition. In communities like mine, where nearly one in five residents live below the poverty line,¹ fresh whole foods are not just scarce, but are also unfamiliar and under-chosen. Cultural norms, limited access, and misleading food marketing fuel confusion about what healthy eating actually looks like. By high school, several of my classmates were already on blood pressure medication, even though many cases of hypertension are preventable through diet and lifestyle.² Nutritional education was minimal, and first-hand exposure to balanced meals was even rarer. These were not personal failures—they were symptoms of a system that never gave us the chance to know better.

Later, while working as a wellness coach at a local gym, I saw how this legacy of misinformation spanned generations. I met parents with fresh sternotomy scars who sincerely wanted to protect their children from the same fate, yet they were unknowingly serving foods with misleading, healthy-appearing labels. I watched them drink “high-protein” shakes, unaware they were packed with saturated fat and sugar. Their confusion was not carelessness; it stemmed from a system that never taught them how to evaluate what they were eating. Food companies profit from this uncertainty: a growing body of research shows that claims like “low sugar” or “gluten free” often appear on ultra-processed foods that contribute to diet-related diseases.³ This confusion is widespread: only 15% of Americans accurately assess the quality of their diets, with most overestimating how healthy their eating habits are.⁴

When I spent time in Spain, I noticed how effortlessly children embraced healthy choices as they grew up eating whole, minimally processed food daily. In Spanish schools, lunches are typically cooked on-site and include an abundance of fresh vegetables, legumes, fish, and fruit—standards shaped by national policy and culinary tradition.⁵ Unlike in the US, where ultra-processed and pre-packaged foods often dominate cafeteria trays, Spanish children grow up with balanced school meals that resemble home cooking.⁶ Children in Spain also consume significantly more fruits and vegetables than their American peers,⁵ and they have much lower rates of childhood obesity at roughly 14% compared to over 40% in the US.⁶ Knowledge of food and nutrition is not learned through misleading food labels—it is shaped by daily habits that are modeled consistently across school, family, and cultural norms.

When I entered medical school, my understanding of nutrition continued to evolve. I used to believe that choosing healthy food was mostly common sense, but I have since witnessed how deeply our choices intersect with access, culture, and mental health. While our curriculum has expanded my knowledge of micronutrient deficiencies, it still lacks adequate instruction on addressing some of the real-world choices people face daily. National surveys show that fewer than 25% of US medical schools require a dedicated course in nutrition,⁷ and the average graduating medical student receives less than twenty hours of nutrition education in total.⁸ Even more concerning, one study found that 71% of physicians felt inadequately trained to provide nutritional counseling.⁹ Yet patients benefit when they do: research shows that individuals who receive dietary counseling from their doctors are significantly more likely to improve their eating habits, despite the fact that fewer than half of physicians include such guidance in routine visits.¹⁰ In underserved regions, where chronic illness is often diet-related, this gap can be especially harmful. Many physicians may never be formally taught how powerful food advocacy is in shaping long-term outcomes, or how to communicate that information in a way patients can apply to their daily lives. Meanwhile, growing evidence links diet to mental health as well: studies suggest that up to 30% of common mental health conditions may be preventable through dietary changes.¹¹

A friend once told me, “I envy kids who were raised healthy—it’s hard to learn that as an adult.” He was right. Research shows that children who establish healthy eating patterns early in life are more likely to maintain them into adulthood.¹² In rural communities like mine, where over 60% of students rely on school lunches as their primary daily meal,¹³ school cafeterias do not just feed students—they shape their lifelong habits.

This realization has caused me to think beyond clinical practice and toward systems-level change. While exploring systemic ways to address food insecurity in my community and others like it, I began researching the history of school-based nutrition policy. That led me to the National School Lunch Program, launched in 1946 to combat malnutrition and bolster national well-being. Though originally rooted in public health, the program gradually shifted toward cost-efficiency—often prioritizing surplus commodities and nonperishable items over nutritional value, even when healthier options were not inherently more expensive. In response, I drafted the American Farm and School Nutrition Support Act—not as a sweeping reform, but as a student-conceived, evidence-informed step toward restoring the program’s original spirit. The proposal envisions reallocating existing USDA commodity funds to help schools purchase fresh, locally sourced foods, reconnecting nutrition policy with its public health roots. I have also begun connecting with national mental health advocacy networks to learn how mental health professionals can support food equity from within their field. This advocacy work reflects what I have come to believe: that change does not always begin in the exam room. Sometimes, it starts in the lunch line.

I never took a formal comprehensive class on nutrition or policymaking. However, I have seen the sorrow of families watching a loved one become incapacitated by preventable illness, then unknowingly offering the very foods that contributed to that harm. In those moments, I wished the world treated nutrition with the same urgency it gives to pharmaceuticals. If there were a pill with the same power as food, there would be national outcry if it were not available on every street corner. Yet, studies show that only 10–20% of health outcomes are shaped by clinical care. The rest come from the social and behavioral factors we too often overlook—including what we eat.¹⁴ In many communities, food is the frontline of health, and frequently the most neglected.

This advocacy work has also led me to draw from history, not just from medicine or public health, but from thinkers who saw food as central to justice and healing. Maimonides, the twelfth-century Jewish physician-philosopher, saw caring for the body through nutrition and prevention as a spiritual obligation.¹⁵ Guru Nanak, founder of Sikhism, established the tradition of Langar, or a free vegetarian meal shared by all, a statement of moral and social equality.¹⁶ Methodist reformer John Wesley distributed guides on hygiene and diet to promote health as a form of spiritual stewardship for the working class.¹⁷ César Chávez fasted to spotlight injustices in food production, using his body as a moral platform.¹⁸ Moreover, long before science formally recognized it, Florence Nightingale revolutionized hospital care by elevating sanitation and nutrition.¹⁹ These figures did not treat food as an afterthought—they understood it as medicine, ministry, and a mirror of society’s values. Their legacies remind me that the root causes of illness often lie not in the exam room, but in the systems that shape what people can afford, access, and understand.

This journey has taught me that school meals are more than nutrition—they are formative moments, shaping how children view their bodies, health, and value in society. Food policy must be grounded not only in data, but in dignity—because school meals shape more than bodies; they shape futures. That is why I will continue this work, even when its effects unfold quietly, one cafeteria tray at a time.

References

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