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The ban and soda and candy is part of an effort to reduce chronic diseases

• New rules taking effect Thursday limit the foods SNAP recipients can buy in five states, including soda and candy.

• The changes are part of a Trump administration push to curb chronic disease by restricting unhealthy foods.

• Retailers, advocates and researchers warn the waivers could create confusion, stigma and higher costs without clear health benefits.

Starting Thursday, Americans in five states who receive government assistance to help pay for groceries will face new restrictions on what foods they can buy, marking a significant shift in the decades-old rules governing the Supplemental Nutrition Assistance Program.

Indiana, Iowa, Nebraska, Utah and West Virginia are the first states to implement federal waivers banning the purchase of certain foods including soda, candy and other items with SNAP benefits. At least 18 states have applied for similar waivers or signaled plans to do so.

The changes affect roughly 1.4 million people and represent a sharp departure from longstanding federal policy that allowed SNAP benefits to be used for nearly all foods intended for human consumption, with limited exceptions.

A push to reshape food assistance

The new restrictions stem from an initiative led by Health Secretary Robert F. Kennedy Jr. and Agriculture Secretary Brooke Rollins, who have urged states to remove foods they consider unhealthy from the roughly $100 billion program that serves about 42 million Americans.

We cannot continue a system that forces taxpayers to fund programs that make people sick and then pay a second time to treat the illnesses those very programs help create, Kennedy said in a December statement.

Administration officials say the effort is aimed at reducing chronic diseases such as obesity and diabetes, which they link to consumption of sugary drinks and processed foods. The policy is a central plank of Kennedys Make America Healthy Again agenda.

Retailers warn of logistical challenges

Retailers and policy experts say the rollout is likely to be rocky. Industry groups warn that SNAP systems are unprepared for the complexity of the changes, which vary by state and lack clear, standardized lists of prohibited items.

The National Retail Federation predicts longer checkout lines, more rejected transactions and rising frustration among customers and store employees.

A report from the National Grocers Association and other trade groups estimates that retailers will face $1.6 billion in upfront costs to implement the changes, followed by about $759 million in annual ongoing expenses.

Advocates say costs will ripple outward

Anti-hunger advocates argue the added costs will ultimately be passed on to consumers.

Punishing SNAP recipients means we all get to pay more at the grocery store, said Gina Plata-Nino, SNAP director for the Food Research & Action Center.

She and other advocates also say the restrictions risk increasing stigma for people who rely on SNAP, particularly when transactions are denied at the register.

A break from decades of policy

Since the programs creation in 1964, federal law has allowed SNAP benefits to be used for any food intended for human consumption, excluding alcohol, tobacco and ready-to-eat hot foods. The Food and Nutrition Act of 2008 reaffirmed that approach.

Past efforts to restrict SNAP purchases including proposals to ban steak, chips or ice cream were rejected after USDA research found such limits would be costly, difficult to enforce and unlikely to improve health outcomes. Under the second Trump administration, however, states have been encouraged and in some cases incentivized to seek waivers.

The new restrictions differ significantly across the five states.

Utah and West Virginia will prohibit SNAP purchases of soda and soft drinks. Nebraska will ban soda and energy drinks. Indiana will restrict soft drinks and candy. Iowas waiver is the most expansive, barring SNAP use for taxable foods, including soda, candy and some prepared items.

Health impact remains uncertain

While administration officials frame the waivers as a health intervention, research on whether SNAP purchase restrictions improve diet quality or reduce chronic disease has produced mixed results.

Public health experts say the waivers fail to address broader structural issues affecting nutrition.

This doesnt solve the two fundamental problems, said Anand Parekh, chief policy officer at the University of Michigan School of Public Health. Healthy food in this country is not affordable, and unhealthy food is cheap and ubiquitous.

The Agriculture Department says the waivers will initially run for two years, with an option to extend them for up to three additional years. States are required to evaluate the impact of the changes, a process that could shape whether the restrictions expand nationwide.

As more states consider similar moves, the debate over how far governments should go in regulating what low-income Americans can buy with food assistance is likely to intensify.

High medication levels can lead to complications

• More than 40% of U.S. adults 65 and older now take at least five prescription drugs daily, a practice known as polypharmacy.

• Studies link high medication use to falls, hospitalizations, drug interactions and slower recovery after illness.

• Clinicians say routine medication reviews and deprescribing could reduce risks without compromising care.

As Americans live longer and manage more chronic conditions, a growing share of older adults are taking multiple prescription medications each day a trend researchers say carries both benefits and serious risks.

More than 40% of adults age 65 and older now take five or more prescription drugs daily, according to recent data, and nearly one in five takes 10 or more. The practice, known as polypharmacy, has become increasingly common as doctors prescribe medications to treat conditions such as high blood pressure, diabetes, heart disease and arthritis.

While many of these prescriptions are medically necessary, researchers warn that taking too many medications at once can put older adults at greater risk for adverse health outcomes.

What is polypharmacy?

Polypharmacy is generally defined as the concurrent use of five or more medications, though experts note there is no universally accepted cutoff. The concern is not simply the number of drugs a person takes, but whether each medication remains appropriate, effective and safe.

Some polypharmacy is unavoidable and appropriate, clinicians say, particularly for patients with multiple chronic illnesses. The problem arises when medications accumulate without regular reassessment.

Health risks tied to multiple prescriptions

A growing body of research has linked higher medication counts to negative outcomes for older adults.

Studies show that seniors taking multiple medications face an increased risk of drugdrug interactions, which can cause dizziness, confusion, falls and emergency room visits. Hospitalizations related to adverse drug effects are significantly more common among patients with high prescription burdens.

Research published in BMC Geriatrics also found that older adults discharged from hospitals on six or more medications experienced slower recovery and greater difficulty performing everyday tasks independently.

Other studies have found that among seniors with Alzheimers disease and related dementias, higher medication use is associated with more symptoms, more frequent hospital stays and lower overall physical functioning.

Experts say age-related changes in kidney and liver function can make it harder for older bodies to metabolize drugs, increasing the likelihood of side effects even at standard doses.

Why medication lists keep growing

The rise in polypharmacy is closely tied to multimorbidity the presence of multiple chronic conditions. Nearly 40% of adults over 65 have two or more long-term illnesses, making multiple prescriptions common.

But doctors acknowledge that medication lists often grow for other reasons. Some drugs are continued long after they are no longer needed, while others are added to treat side effects caused by existing prescriptions, a pattern known as a prescribing cascade.

Fragmented care can also play a role, particularly when patients see multiple specialists who may not be fully aware of one anothers prescriptions.

Push for medication reviews and deprescribing

To address the risks, clinicians and health systems are increasingly calling for regular medication reviews structured evaluations that assess whether each drug is still necessary and beneficial.

Deprescribing, a process that safely reduces or stops medications that no longer provide value, has gained traction as a way to improve patient outcomes without compromising treatment.

The goal isnt simply to reduce pill counts, researchers emphasize. Its to make sure every medication has a clear purpose and that the benefits outweigh the risks.

Better coordination among healthcare providers and clearer communication with patients are also seen as key steps in preventing unnecessary polypharmacy.

A growing public health challenge

As the U.S. population continues to age, experts say managing medication safety will become an increasingly urgent public health issue.

Balancing effective disease treatment with minimizing harm from excessive medication use, they say, will require ongoing attention from clinicians, patients and policymakers alike especially as longevity increases and more Americans live longer with chronic conditions.