Food changeWhy do we care so much about food? On the surface its very simplewe need nutrients for every physiology process but is much more than just fuel. It represents stories passed on from generation to generation, it is at the core of every culture and many social experiences are structured around food. We seek out food and it is integrated in our dopamine reward system. But food has changed dramatically in the past several decades. Modern agriculture and food science practices have dramatically changed what food looks like and there are profound consequences to these changes. Although our biochemical understanding of micronutrient deficiencies has expanded greatly and with modern food science we can now easily and accessibly address these, it has also led to highly palatable energy dense ultraprocessed food that is ubiquitous in our society. For example, food swamps are communities that are not close to health food options such as supermarkets and farmers markets, with increased abundance of fast-food restaurants, convenience stores, bodegas (1) which have more energy dense ultra-processed food options than fresh nutrient rich produce (2). Studies have demonstrated a strong association between food swamps and obesity, including being a stronger predictor of obesity than a lack of full-service grocery stores (2). It is no coincidence that the age of access and excess of ultra-processed calorie dense foods has seen alarming trends in obesity (3) and cardiometabolic disease (4). Obesity is a complex multifactorial disease with numerous variables that impact the risk of development and progression including genetics, epigenetics, environmental, and socioeconomic factors, to name a few. Of the factors that contribute to obesity, calorie excess and ultra-processed food consumption are major contributors (5). Our trajectory is deeply concerning with current obesity projections of 1:2 US adults having obesity by 2030 (6). Obesity is linked to significant health care utilization resulting in over 170 billion dollars in associated annual healthcare costs (7).