The Mind-Body Connection and Mental Health: A Public Health Response
Mental health is often treated as something that lives only in the brain. But that framing is too small.
In a recent episode of The Secretary Kennedy Podcast, Dr. Ellen Vora discussed the “mind-body connection,” arguing that anxiety, depression, and other mental health challenges are shaped by sleep, nutrition, inflammation, blood sugar, social connection, technology, movement, and the conditions of daily life. It is a compelling conversation because it pushes against an overly narrow view of mental health care. Medication and therapy matter. But so do food systems, school environments, work schedules, social media design, neighborhood safety, community belonging, and access to green space.
That is where public health has something important to add.
A whole-person approach to mental health should not become another way to tell people to fix themselves. It should not shame families for eating ultra-processed foods when those foods are cheap, available, heavily marketed, and often the only realistic option after a long day. It should not tell young people to simply “get off their phones” while ignoring the billion-dollar platforms designed to keep them scrolling. And it should not tell people to exercise more without asking whether they have safe sidewalks, parks, time, childcare, or physical ability.
The better question is not just, “What choices should individuals make?” It is, “What conditions make health possible?”
This article comments on key moments from the podcast through a public health lens. The goal is to separate promising evidence from overreach, keep equity at the center, and ask what it would take to build mental health systems that are not only more holistic, but also more just.
In this piece, we take in a deep dive into the conversation in what we hope will be a limited series. We walk through the conversation and pause at key moments. Our comments will be interjected and highlighted in this blue-ish color.
Ellen Vora: When we think about mental health as separate, we’re missing that there’s no separation between the mind and the body. What’s occurring in the physical body is impacting the health of the brain and therefore it’s impacting our mental health.
Secretary Kennedy: Hey everybody. I’m Robert F. Kennedy Jr., your HHS secretary. Welcome to the Secretary Kennedy Podcast. Today, my guest is Dr. Ellen Vora, who’s a board certified psychiatrist who’s helping to reshape how we think about mental health and the links between our food, our environment, and the mental health illnesses that are now epidemic and particularly in our children. She trained at Yale and at Columbia and she got her MD there and she works bringing together conventional psychiatry with a deeper focus on nutrition, sleep, inflammation, and lifestyle. Dr. Vora challenges the idea that mental health conditions exist in isolation from the body and instead looks at the full picture of what drives how we feel and how we function. She’s been a leading voice and advancing a more whole person approach to care and she recently joined us to speak at HHS’s National Conference on Women’s Health and welcome to the podcast, Dr. Vora.
Ellen Vora: Thank you.
Secretary Kennedy: I always talk about this idea that we’re suffering in our country and across the world, spiritual malaise and that it affects our minds and our bodies. We’re seeing this explosion of physical ailments in our kids in chronic disease, autoimmune diseases, neurological disease, allergic diseases, obesity, et cetera. But we’re also seeing coterminously this explosion of anxiety in our children and depression and a feeling of isolation and disconnection. And you think that that also is related to biological issues. Can you talk about that at all?
Ellen Vora: Yeah. So my training in allopathic medicine, we’re hyper specialized. We think about it as the body is a collection of discreet separate organs. One person’s focused on the kidney. My purview was the neck up that this is where mental health happens. When I became exposed to older Eastern modalities, things like Chinese medicine, Ayurveda, it was an unlock for me to see how they think about the body, health, healing. They’re seeing this as an interconnected web. And I think they got this one right. When we think about mental health as separate, we’re missing that there’s no separation between the mind and the body. What’s occurring in the physical body is impacting the health of the brain and therefore it’s impacting our mental health. And I often say with my patients, your gut and your brain are talking to each other even if your gastroenterologist and your psychiatrist are not.
Public health has long known that mental health is shaped by sleep, food, stress, housing, trauma, social connection, work, environmental exposure, and access to care. The mind-body connection is not fringe. The more important question is how we translate that insight into fair, evidence-based systems of care. If we only tell individuals to eat better, sleep more, and reduce stress, we miss the bigger forces shaping those choices. Food deserts, unsafe neighborhoods, long work hours, poverty, racism, medical mistrust, and lack of affordable care all shape what “healthy choices” are available in the first place.
Secretary Kennedy: Yeah. I mean, the gut brain connection is now something that is clearly and uncontestly documented by science. The microbiome in the gut is our largest organ system and people are starting to see now how it affects move. What does Western science say about that?
Ellen Vora: Western science is catching up to what Eastern science, naturopathic medicine, functional medicine have been saying for a very long time, which is that there are multiple pathways by which the gut is impacting mental health and every aspect of physical health. It’s connected to systemic inflammation. It is where roughly 90% of our serotonin is manufactured. It’s intricately connected to our whole neurotransmitter ecosystem. So it’s directly impacting our mental health. It’s also communicating with the brain constantly via the vagus nerve. And we often think about that in a top down way, that if we’re chronically stressed, that’s impacting our digestive health. And that’s true. But what’s also true is that the gut is communicating back up to the brain. It’s bottom up. So the health of our gut is impacting our mental health and it is very difficult in modern life to have a healthy gut. There are many aspects of modern life that are compromising our microbiome and our gut lining.
The gut-brain connection is real, but it is easy to oversimplify. The microbiome is involved in immune function, inflammation, metabolism, and brain signaling, but we should be careful not to turn every mental health condition into a gut-health problem. The evidence points to a connection, not a universal cure. A public health framing would ask: Which interventions work, for whom, under what conditions, and with what risks? That means testing dietary, clinical, behavioral, and social supports together, not replacing one narrow model with another.
Secretary Kennedy: One of the people who also spoke at the women’s health conference was Dr. Chris Balmer from Harvard and he’s actually done peer reviewed studies that showed dramatic decreases in the symptoms of schizophrenia from dietary changes. Can you talk about that science and what other sciences out there that conventional peer reviewed placebo controlled or controlled studies?
Ellen Vora: Yeah. So in my psychiatry residency training and in my medical school, I believe I got about 16 minutes of nutrition education. And in retrospect, I think a lot of it was misguided. And what we know, which feels like just common sense is that what we eat impacts our physical health and our mental health. The fact that we need data to support this fine, it’s understandable, but here we are. We now have a 2022 meta-analysis. I think it looked at some 385,000 participants over the course of 17 studies that showed that the people who consumed the most ultra-processed food had a 44% increased odds of experiencing depressive symptoms, 48% increased odds of experiencing anxiety symptoms compared to those who ate the least amount of ultra-processed food.
A 2022 systematic review and meta-analysis found that higher ultra-processed food consumption was associated with increased odds of depressive and anxiety symptoms. But association is not the same as causation. People who eat more ultra-processed foods may also face more financial stress, less access to fresh foods, unstable schedules, unsafe neighborhoods, or chronic stress. The equity issue matters here. Ultra-processed foods are not just individual “bad choices.” They are the predictable result of food pricing, marketing, zoning, agricultural policy, school food systems, retail access, and time poverty. A justice-centered public health response would not shame families. It would make healthier food easier, cheaper, culturally relevant, and available.
Secretary Kennedy: Are there any data on specific diseases like bipolar disorder or other specific diseases and changing the food environment?
Ellen Vora: Bipolar for me is a place where I am more in hypothesis than I can point to the research, but I think a lot about the nutritional component of bipolar. It is something where I’m really aware of Chris Palmer’s work and the way that metabolic health and in particular insulin resistance seems to play a role in the pathophysiology of bipolar. Bipolar, in my opinion, what draws my attention is the fact that a lot of the same medications that treat seizure disorders are also effective for bipolar. So I think we can take some takeaways from the playbook of how we approach seizure disorder and apply it to bipolar disorder. Certainly social rhythms therapy and circadian rhythm is critically important with bipolar. The idea that our body functions best when we’re synced up with our circadian rhythm with the time of day, sleeping at night, awake with the sunlight, but then there’s also a role for metabolic health and how our body is managing glucose and insulin.
And this is where the modern American diet is so conducive to a state of insulin resistance and dysglycemia or the body struggling to manage blood sugar appropriately. So I think that’s playing a role in the pathophysiology of bipolar and when we step back to think about why is this happening? Does it have to be happening? What can we do to address underlying root causes? I always have an eye towards nutrition, towards anchoring meals with healthy fats and protein to help a patient keep their blood sugar stable.
Secretary Kennedy: Yeah. I mean, there’s so many, this generation, there’s probably no real strong science on this, but my observation is that this generation of kids, I have seven kids and I meet all their friends and the level of anxiety in these kids is something that I’ve never seen before in my life that I haven’t experienced. I had 11 siblings and close to 70 first cousins. I was surrounded by children my whole life and I never heard anybody talk about their anxiety maybe because we just didn’t talk that much about that stuff in those days, but it just seems to me from my own observations that the anxiety levels are off the chart. They’re almost disabling in many of these kids. And it’s hard to put your finger on what’s causing it because there are so many co-variables. There’s the food, particularly the ultra processed food. There’s cell phones and cell phones may impact us in two different ways.
One is the social media addiction and the other is the direct radiation from the cell phones. And then there’s just so many other challenges that they have to face that we didn’t face a generation. They’re not outdoors.
The schools are different, all of these things. How do you separate those?
Ellen Vora: Yeah. So I’m an adult psychiatrist. So when I’m thinking about child adolescent mental health, it’s not from my professional expertise, but living in the world, caring about this, I’m a parent. And I think about how on a physical level there’s a lot contributing to the anxiety levels we see in kids from being inflamed and micronutrient deficient and having missing microbes in the gut all the way to circadian rhythm disruption that is, we come by this honestly with screen use and endless scroll keeping us up too late, lack of nature, pressures that kids are under. I think they also have a lot of, they’re feeling viscerally connected to the state of the world to what’s not going right. And I honor that, that kids are really feeling that on all of our behalf, but I also really think social media is playing an outsized role in this issue.
I look to the research of Jean Twenge, which was showcased in Jonathan Hite’s book, The Anxious Generation, where we see that these anxiety levels and pretty devastating mental health trends, especially in female adolescent health, that’s happening and it’s tracking with the ubiquity of smartphones and then social media.
Secretary Kennedy: I mean, all of these kids spend, I think now the average is about 5.5 hours per day if they’re spending on social media. And that was time when we were outdoors when I was a kid and we were playing sports. We were doing things that I think increase opportunities for self-esteem. You get self-esteem from doing esteemable things, from making yourself better, from enduring challenges, from enduring pain, living through it. And it just seems like doomscrolling is a waste of time, that there’s just no benefit coming from it.
Ellen Vora: Or more harmful than even just wasting time. But that’s right. When we’re outside in nature, active, interacting with other kids, the wiring that’s occurring in that seemingly normal, this is a developmental process where kids are learning to collaborate, understanding social atunement, but they’re also taking reasonable risks and learning boundaries, learning resilience and grit and they’re learning self-efficacy that they’re presented with a challenging situation and then they witness themselves overcome it. And that’s critical to grow up and see yourself capable of failing and picking yourself up and moving on, of seeing yourself as having a meaningful role to play that you can make a meaningful contribution. I think Jonathan Hite puts it so well when he frames it, especially in his earlier book, The Coddling of the American Mind, how we are creating safetyism, treating children as if they’re fragile and they’re actually anti-fragile, but when we put so much padding around them, then they take on an internalized sense of themselves as being fragile.
And I think that directly contributes to anxiety, to poor mental health and it limits, it makes their lives smaller.
There is reason to be concerned about youth mental health and digital life, especially when social media displaces sleep, physical activity, in-person relationships, and unstructured play. The U.S. Surgeon General’s advisory on youth social media noted both potential benefits and harms, while calling for stronger research, safer design, and more protections for children and adolescents. But we should be careful about simple explanations. “Screen time” alone is a blunt measure. What young people do online, how they feel afterward, whether they are being harassed, whether they are sleeping, and whether they have strong offline support may matter more than minutes alone. A public health approach would avoid moral panic and focus on safer platforms, healthier school norms, parent support, sleep protection, and youth voice.
Secretary Kennedy: Do you run into it to olds or addicted to social media?
Ellen Vora: Yes. It’s rare I run into adults who are not addicted to social media.
Secretary Kennedy: And how do you treat them other than just saying throw away your cell phone?
Ellen Vora: Yeah. So usually I’m always meeting people where they’re at and trying to be realistic, bite-sized pieces. The goal might be deleting these apps, putting the phone on Grayscale, no longer having a relationship to this platform that we know is addictive, but along the way, a step where I might begin with a patient is protect the bookends of the day, the first hour of the day, the last hour of the day. I think that’s most impactful. And one of the ways we can do that is by not bringing the phone into the bedroom at night, not keeping it on the bedside table, not scrolling right before bed for a number of different reasons. I’m concerned about the blue spectrum light and its impact on melatonin secretion and circadian rhythm, but I’m also just concerned about the fact that these apps are designed to have what’s called endless scroll.
So unlike a book with chapters that can cue us and say, “This might be a good time to put the book down and go to bed,” the phone is designed to hold our attention, never cuing us to pause and therefore we scroll endlessly, we stay up later than we otherwise would and the algorithm favors upsetting content, controversial content. It leads with fear and even rage baiting. And so where we find ourselves is we feel on some unconscious level surrounded by danger right at the moment where we need to feel safe enough to surrender into sleep. So that intervention alone of moving your charger, setting up your phone somewhere else not next to the bed while you sleep at night is very impactful to get you started on a path where you’re less set up to doom scroll for hours of your life.
Secretary Kennedy: I mean, one of the things everybody’s worried about now is what’s going to happen particularly the next generation with the proliferation of AI. And are you seeing that in adults now of people developing these relationships to the exclusion of human relationships? Yeah.
Ellen Vora: It’s nuanced and I feel like my jury is still out. I don’t yet have my conclusions. I’m still percolating on all of this. I currently see costs and benefits. I see patients that are rather than meeting with me for one hour a week in an ongoing dialogue, almost as if it’s playing a role of a therapist. And I find that what they bring to me in session, what they’re learning from these different LLMs, it’s actually pretty insightful and it’s calling them out and giving them a lot of moment to moment support. But I’m also concerned because unlike a practitioner, it can’t follow up with someone necessarily and there’s still a way that it is designed to be sycophantic because they of course want to keep customers coming back and that’s not always the best approach to helping us grow. But I think what we’re going to see is a lot of good and I think a lot of concerning changes and risk and I’m still just sitting back and watching that and still trying to decide where I land on it.
This is exactly the right level of caution. AI tools may offer reflection, coaching, and low-barrier support, especially for people who cannot access timely mental health care. But they are not therapists. They may miss risk signals, reinforce distorted thinking, provide inaccurate advice, or create dependency. The public health question is not “AI good or bad?” The better question is: What safeguards are needed before AI becomes part of mental health support? That includes crisis protocols, transparency, privacy protections, bias testing, referral pathways, and clear boundaries about what the tool can and cannot do. Equity also matters. Poorly governed AI could become a lower-quality substitute for care in under-resourced communities while wealthier people continue to receive human support.
Secretary Kennedy: Back to the subject of food, have you looked at any of these prison studies where they change the food and the prisons and juvenile detention facilities and they see dramatic drops in violence and acting out. And the same thing with schools when they see testing scores dramatically and disciplinary problems diminish all testing scores increase.
Ellen Vora: Yeah. So the brain is a physical organ and we put mental health as this kind of rarefied thing of this is psychology. And while that’s valid, what’s also true is this is a physical piece of flesh influenced by everything going on in the physical body. Mental health is physical health and what we’re eating, if it’s pro- inflammatory, if it is nutritionally bankrupt and therefore we’re not getting all the micronutrients that a brain needs to function, if there are substances that can create a state of hyperactivity or inattention, all of that is going to impact what we call mental health and even blood sugar stabilization. I have a patient in my practice who, she had come to me after years of seeing different psychiatrists, therapists, trying multiple different medication regimens to treat panic disorder. She would frequently have panic attacks on her commute home from work.
And when she came to see me, I kind of took a bird’s eye view of the whole picture and had to reckon with the fact that I wasn’t going to come up with some new medication regimen that she hadn’t already tried. She’d already done CBT or kind of behavioral therapy, so had to think more creatively. And I noticed in her blood work that her body was dysglycemic, she was insulin resistant. So what we did was we anchored her meals with protein, with healthy fats, we reduced refined carbohydrates and added sugars. We simply took measures to stabilize her blood sugar and that was actually what did the trick for her to stop having panic attacks. Viscerally, I’m uncomfortable with the fact that there’s so much unnecessary suffering. We think of mental health as weighty and this almost untouchable biochemical process, but sometimes there are very mundane ways that we can support the body, help support physiologic bEllence and then decades of panic disorder can just resolve with something like stabilizing blood sugar.
Secretary Kennedy: You talked about medication and your profession I think recently has gotten a bad name for overprescribing, particularly psychiatric drugs, SSRIs, those kind of things. And people nowadays often see a psychologist and the reason they go see a psychiatrist is to get on the meds. Are you an outlier in your profession?
Ellen Vora: I am an outlier and the way I think about healing is that it’s similar to summiting a mountain where the summit, getting to the top, that signifies you feel energetic, clear, stable, hopeful, resilient. That’s the goal is to help someone get to there where they’re thriving. And what’s happening in my field, which I think is a crisis in psychiatry, is that we have up until now really only offered people two well-worn paths up this mountain of healing, medication, psychotherapy. And for some patients, one of those or some combination of those paths gets them all the way to the summit and that’s cause for celebration. I’m a psychiatrist, I prescribe medication, I’ve helped patients get to the top of this mountain through medication and psychotherapy. It’s a beautiful thing. But what I’ve observed over now 14 years of practice is that not everyone gets to the summit through those paths, that some people hit a dead end and sometimes repeatedly where they’ve tried every medication combination, every dose, every therapeutic modality, augmentation strategies, and they’re still stuck halfway up that mountain.
And that’s where pretty dangerous thoughts can take hold. People can feel hopeless. They can begin to despair. They feel like this was supposed to work, didn’t work for me so I’m out of luck. And if my mission on earth is anything, it’s just to help catch anyone stuck halfway up the mountain who’s despairing and let them know they’re not stuck. There’s hope and the disservice my field has been doing has been saying, those are the only paths. When in fact, when we hit a dead end, what we actually need to do is pivot. There are other paths up this mountain. They have not been given the main stage. They’re not the public conversation about mental health, but that’s where I think we need to move the conversation is to say dietary support, lifestyle modifications, newer modalities like transcranial magnetic stimulation, even psychedelic therapy. These all have a place as a different path up that mountain.
And I think that’s where I would like to see the field shift over time is that we don’t give up and keep hitting up against a dead end.
Medication and psychotherapy help many people and should not be dismissed. At the same time, many people do not fully recover with those tools alone. A broader care model should include sleep, movement, social connection, trauma-informed care, nutrition, economic stability, and community belonging. The risk is creating a false either/or: medication versus lifestyle. Public health should reject that framing. The real goal is stepped, person-centered care that includes evidence-based clinical treatment and upstream supports. People should not be shamed for taking medication, and they should not be denied access to non-medical supports that could help them recover.
Secretary Kennedy: And then how do you personally treat a patient? How is that different than what other people in your profession do? Do you look at their diet? Do you look at their long-term health medical records? Because that’s something a lot of psychiatrists wouldn’t do at all.
Ellen Vora: I look at all of it and I look at physical health and I really consider the full portrait of my patients’ lives. It’s not just their psychiatric history, their medication trials. I’m thinking in terms of what does their life look like from the minute they wake up to the minute they go to sleep and how did we get here where we only have those two paths up the mountain? I think that my field has really come of age with a particular narrative of making sense of mental health. It says, our mental health issues are the result of a genetic chemical imbEllence. It’s your serotonin. And not only is that our least hopeful kind of fixed trait understanding of mental health, but it’s not wholly accurate. A 2022 umbrella review of all of the lines of research around serotonin found that there is no connection, no correlation between serotonin activity and states of depression.
It’s not to say our medications that are intended to modulate serotonin are not effective. They can certainly be effective, but that narrative has been an oversimplification. And I prefer a growth mindset view of mental health to say if someone is experiencing symptoms of depression or anxiety that this is not a direct translation of their genes, it’s not an inevitability. This is a communication from the body. It’s saying something’s out of bEllence here. There are modifiable root causes of mental health issues. So we can step back and say, okay, what’s going on here? Is there physical imbEllence? Is there unresolved trauma? Are there social considerations? Are there unmet needs? And I think my field has also been overlooking the fact that as human beings, we have certain fundamental needs. We have a need for community. We are social creatures. We have a need to feel that what we do matters that we’re making our contribution.
The serotonin theory has indeed been challenged. A major umbrella review concluded there was no consistent evidence that depression is caused by low serotonin levels or activity. But that does not mean antidepressants do not work, nor does it mean people should stop medication abruptly. The more accurate takeaway is that depression is not explained by a single chemical imbalance story. It is shaped by biology, trauma, chronic stress, social conditions, sleep, inflammation, meaning, grief, relationships, and access to support. Better science should make care more nuanced, not more punitive.
And so when I approach mental health differently, I’m always thinking about these root causes of our mental health issues and I believe we have agency around that. These are things that we can start chipping away at to make a difference in how somebody’s feeling.
Secretary Kennedy: And when you go to a professional convention or are you like the skunk in a garden party?
Ellen Vora: Yeah. I think that I don’t love that image of myself, but I think it’s fair to say, and I have so much sympathy. I went through the same training as my colleagues. People don’t go into medicine for, it’s not for money, it’s not for ego. It’s certainly not to bump your head up against a dead end when you’re supporting your patients. We went into this because we felt a calling for it because we want to help and I think there’s a real despair even among practitioners. People are very burnt out. We have high suicide rates. There’s even moral injury because it’s difficult to make it through a decade plus of training where you’re taught one framework, one paradigm for understanding mental health and then to realize that your patients aren’t always getting better. And I think even sometimes we have to reckon with the fact that occasionally our interventions do harm and I think that is very difficult for us to face.
So I have a lot of sympathy for how we get stuck, but I also have a lot of hope because this understanding of mental health that we can resolve something at the root rather than simply suppress symptoms, once you see that, you can’t unsee it. And I think we are slowly, you’re seeing a slow shift towards more of these approaches to mental health.
Secretary Kennedy: What is your advice? I know you’re an adult psychiatrist, but what is your advice to parents or to teens who are suffering from these and they maybe don’t have the time or the resources to see a psychiatrist as you know in rural areas around this country, there’s just no psychiatrist and there’s nobody to say. So what would you say to a mass audience about what they can do to escape this kind of gerbil wheel of depression and anxiety and overexcitement?
Ellen Vora: Yeah. So I learn a lot from my friend and colleague, Dr. Becky Kennedy, and she talks about the fact that if we introduced a device, a tablet, a social media app, a game, and then over time we came to realize this was a mistake. We can roll that back. Will our kids protest? Will they say, “I hate you, you’re the worst parents?” Maybe, possibly, likely even, but that dynamic is okay. It is okay for our children to learn to tolerate discomfort and disappointment and boredom and it’s okay for us to have to be the bad guy sometimes in order to do what’s best for our kids. I want people to know that if they feel stuck in having too much of their children’s lives be taken over by technology, they can come in and say, “There’s a new sheriff in town and we’re doing things differently going forward.” There’s a book now by Jonathan Hite called The Amazing Generation, which helps motivate kids, really give
Secretary Kennedy: Them- What is it called? It’s
Ellen Vora: Called The Amazing Generation to help kids see the reasoning behind this because kids want to be spoken to with respect about this and to get their buy-in through showing them the data. But I also think that I think this was an emergent phenomenon, but we have a state right now where we think of mental health as something gatekeeped, something a bit out of reach and that’s where the treatment gap and the difficulty with accessing mental healthcare can feel so dire. And I hold a complex view about that because I know that when we do increase access, that doesn’t always lead to desirable outcomes. And so sometimes, and this is so nuanced, but I think where we really need to start is making sure that our medical school education, psychiatry residency and all of therapeutic modality training, that they’re already thinking about root causes, they’re thinking holistically about patients so that once we increase acces, that is more likely to lead to a positive outcome.
But I think for people at home, the beauty of this more root cause resolution diet lifestyle approach to mental health is that this doesn’t require a white coat or a prescription pad. It’s not even something we necessarily need to gatekeep because it is generally not risky. These are things that are safe and even rather than having side effects, they have side benefits. There are things that are generally helpful and healthy. So when someone wants to support their child thinking about it as sometimes just a glorified house plant, we need healthy soil, we need water, we need sunshine. We need to give this body the inputs that it requires to function well from nutrition and stable blood sugar, good rest, movement, connection to nature, connection to community, a feeling of purpose and meaning in life. And I think the most important thing we can do as parents is atunement.
We don’t need experts for everything. Sometimes the most important credential is just the fact that we are human, we are co-regulating with our children and if we can hold a regulated nervous system, we help create that it can ripple out to our kids. So I think we actually can do more than we realize.
Secretary Kennedy: And what’s the role of physical exercise?
Ellen Vora: Yeah. So we have data now that show that physical exercise is comparable to antidepressants in the treatment of depression and anxiety. And even if we get that memo, usually the hardest part around exercise is not the knowledge we know. We know we should exercise. It’s the behavioral change. And again, with patients, I’m always thinking about what’s the smallest bite size piece that I can suggest so that it’s more realistic someone will take me up on this recommendation. With movement, I think the difference between doing nothing and anything at all is so impactful that I am reassured by that data. When I have a patient who says, “I don’t exercise, I don’t have time, I don’t have energy, it feels impossible.” My go- to recommendation is to take a 10-minute walk after dinner and the physiology behind why that What’s effective is that typically dinner is our largest meal and then we’re sedentary and then we go to sleep and that’s a perfect storm for insulin resistance.
Simply taking a walk around the block after dinner starts to activate our leg muscles, these large muscles in the body, those muscle cells put up their insulin receptor and suddenly we’ve created a milieu of insulin sensitivity in the body instead. And so that can set someone down a different trajectory in terms of their cardiovascular risk factors but also their mental health. And that’s reasonably doable for many people. And when that’s not feasible, lifting heavy things, dancing has actually a lot of data to support how it’s impacting our physical health, but also our mental health directly in the way that it seems to help us release some of what we hold onto.
This is one of the most practical parts of the discussion. Exercise has strong evidence as a mental health intervention. A 2024 BMJ systematic review and meta-analysis found that exercise produced meaningful reductions in depressive symptoms, with walking or jogging, yoga, and strength training among the more effective approaches. The equity framing is essential. “Exercise more” sounds simple until we ask who has sidewalks, safe parks, time, childcare, disability accommodations, or freedom from multiple jobs. The smallest feasible step, such as a 10-minute walk, may be realistic for some people. For others, the intervention has to be environmental: safer streets, access to recreation, green space, school recess, workplace flexibility, and community-based movement options.
Secretary Kennedy: And is there anything good about ultra process foods?
Ellen Vora: This is not my first rodeo in working with people around food. And I would say if we could go back in time and there was never the advent of ultra processed foods, then it would be comfortable to say there’s absolutely no redeeming qualities of these. Maybe for apocalyptic times, the fact that they’re shelf stable will be helpful. But I think where we are right now with there’s a question of morality around food that we’ve even weaponized this idea that if you’re telling someone to eat healthier, that that is ableist. And I think that I recognize that we are in just such a state of tribal warfare around food. And my message to people is always to generally when possible, eat real food, generally when possible avoid fake food. But when you can’t, don’t overthink it because that can sometimes make us believe that we’re fragile, that can put us in a state of fear and stress.
We can start to get into even a victim mentality around, but I don’t have access to this. And I don’t think any of that is helpful for our physical or mental health. So we want to make these changes gradually over time in our lives with a light grip and always from a place of self-love, of self-respect and with dignity rather than feeling forced or obsessive or perfectionistic. So I don’t think they’re beneficial to the body, but I think sometimes we need to incorporate more ease into our choices, especially for getting bogged down by feeling that it’s too difficult.
Public health has to be honest about the harms of ultra-processed food environments without blaming people who live inside those environments. Food is not just nutrition. It is culture, comfort, survival, time, money, transportation, labor, stress, and marketing. The best public health message is not “try harder.” It is “people deserve better options.” That means healthier school meals, limits on predatory marketing to children, better wages, affordable groceries, SNAP and WIC modernization, local food infrastructure, and policies that make the healthy choice the easy choice.
Secretary Kennedy: Well, thank you very, very much, Dr. Vora. This is all the things that you’ve been saying are aligned perfectly with President Trump’s executive order and our great American Health Initiative. And so thank you for everything that you do.
Ellen Vora: Thank you so much. It’s an honor to be here.
Produced by the US Department of Health and Human Services.
The podcast raises important questions that public health should take seriously: How do food, sleep, movement, social connection, technology, trauma, and environment shape mental health? Where the conversation is strongest, it moves beyond a narrow medical model and asks what people need to thrive.
But the next step is evidence and equity. We need to know which interventions work, for whom, and under what conditions. We also need to avoid turning systemic failures into individual responsibility. A whole-person model of mental health should not mean telling people to fix themselves. It should mean building communities, policies, schools, food systems, workplaces, and care systems that make health more possible.
