As a veteran of nutrition and public health work in the United States, Marion Nestle is known for her tenacious writing and advocacy work. She is a Paulette Goddard Professor of Nutrition, Food Studies, and Public Health emerita at New York University, a current visiting professor of nutritional sciences at Cornell, and a previous lecturer at UC Berkeley, where she received her PhD in molecular biology and her MPH in public health nutrition. An author of over 10 books that range in topics pertaining to the influence of money, power, and marketing on nutrition in the United States, she also hosts a daily blog on her foodpolitics.com website, which discusses current public health- and food-related topics. Marion Nestle's reputation precedes her as an unabashed champion for integrity in our food system.

In her most recently published book Unsavory Truth, Nestle's attention turns toward the relationship between food companies and nutrition research. She begins her book with a treatise as a self-proclaimed lover of food science—a sincere concern for the ways in which the food industry influences nutritionists, even against the interests of public health

Nestle opens with a cautionary tale of drug companies and their influence on health professionals. In this, the second chapter, she outlines a history perhaps familiar to the general public. The ways in which medicine has been marketed to doctors is a narrative that has been told in popular movies like the 2010 ‘Love and Other Drugs’, so it is no surprise that in 2009, while 84% of physicians reported receiving gifts or payments from pharmaceutical companies, 90% denied these having any effect on prescribing habits. Nestle outlines the psychology around gift giving and the research showing that it biases not only providers but the recommendations of FDA drug advisory committees and medical research itself. This chapter is even more poignant in the context of the current opioid crisis and tangle of litigation surrounding companies accused of downplaying dangers and overplaying benefits of prescription painkillers.

Marion Nestle then draws parallels between the drug and food industries but argues that defining the influence on nutrition professionals is more difficult, as impacts are particularly challenging to measure. She outlines the unique challenges of nutrition science research, citing the complexity of food metabolism, the necessity of food and our attachment to it, the cost of this research, and the reality that nutrition science's history is both conflated with but diverges from the priorities of food science. Nestle explains how pervasive, yet susceptible single nutrient- and single food item-focused research is to the biased influence of funding. She shares observations of food industry impact on national health research and outlines the 11 published research articles looking further into the topic, arguing that while the data are limited, findings suggest bias similar to that of healthcare providers with drug companies.

In the proceeding chapters, Nestle provides case studies to illustrate these points. She discusses the ways that sugar and candy have been marketed as health foods, issues pertaining to the USDA's checkoff-funded research, and devotes an entire chapter to Coca-Cola itself. Perhaps one of the more insightful chapters is when Nestle delves into research on ‘healthy foods’, citing shortcomings of seemingly innocent food items. Examples include trade associations such as Maine Wild Blueberries and Federal Marketing Orders that promote research for specialty crops like pecans. The issue in these cases is not with the harm done by food items, but with the nature of research focused on single food products. The accounts begin to sound so similar to each other; it is no longer surprising to the reader when research findings for a given food item suggest that consumption will do anything or everything on a list ranging from reducing weight and improving cognition, to curing erectile dysfunction.

The second half of the book provides a reflection on the field nutrition more broadly, covering topics such as conflicting interests of advisory committees and industry influence on nutrition education and dietetic societies. Nestle's writing is clear, accessible, and to the point. She provides documentation for her concerns and reflects on her own decisions, particularly how to manage conflicting interests with funding and industry influence. She outlines exchanges with the Associated Press’ Candice Choi, author of an article that detailed Nestle having received travel expenses from a non-profit ‘Feed the Truth’, funded by the snack bar company, KIND. In this context, Nestle shares her policy for gifts from food companies. She accepts reimbursements for travel, lodging, and meal expenses, but does not personally accept honoraria, consulting fees, or direct payments. Nestle requests that such payments to be made to the Marion Nestle Food Studies Collection at New York University or to the department's student-travel fund.

In this book, the readers work toward a conclusion in which they are left with more questions than answers. It opens us to an expansive view of the nutrition landscape and its flaws, only to leave us in uncertainty. In the last few chapters, Nestle discusses ethical topics such as the discomfort of disclosure or managing conflicting interests, again citing some of her personal policies. These examples emphasize the cyclic nature of such difficult questions, that is, inconsistencies remain even within her own practices. In the last chapter ‘Stakeholders: Take Action’, she provides broad questions foundational to the book, such as ‘What should universities and nutrition journals do to protect their scientific integrity?’

In this way, the self-reflective nature of Nestle's writing is valuable. The book seems an invitation to nutrition science researchers and dietetic professionals themselves, raising critical concerns at the foundation of the discipline's integrity. These conversations may be obvious to food systems scholars but seem latent or marginal within the field of nutrition itself. With the detailed exchanges and fascinating research that Marion Nestle provides as a backdrop, the final chapters allow the reader to imagine potential for and implications if nutrition science were to more directly address industry influence. Unfortunately, it seems the response to the book from field nutrition science itself has been almost complete silence.