WASHINGTON (Reuters) -The U.S. government will address what it sees as an epidemic of chronic illness among American children, calling for changes such as offering full-fat milk in cafeterias and limiting marketing of food and drugs, the "Make America Healthy Again" Commission said in its second report on Tuesday.

The commission, established by President Donald Trump through an executive order and led by Health Secretary Robert F. Kennedy Jr., a long-time anti-vaccine crusader, builds on a May commission assessment.

That report linked processed foods and over-prescription of medications and vaccines to rising rates of childhood obesity, diabetes, autism, and ADHD. It also alarmed food industry groups for pointing to pesticides like glyphosate, a key weedkiller ingredient that is the subject of thousands of lawsuits, as a potential health risk factor. 

The latest strategy document, the contents of which were first reported in early August based on draft copies provided to sources, calls for changes to school diets, such as offering full-fat milk, and proposes investigating vaccine and prescription drug safety.

It notably stops short of recommending changes to U.S. agrochemical approval or regulatory processes, a key demand of some MAHA activists.

Rather, the report says the Environmental Protection Agency will work to build public confidence in its pesticide review process and reform its agrochemical approval process to ensure their "timely availability" to farmers.

Health advocates and other experts said last month that the recommendations in the draft lack scientific grounding and do little to address the real causes of poor health among children.

The report calls for increased federal oversight and enforcement of direct-to-consumer prescription drug advertising, with a special focus on violations involving children, social media, and telehealth.

The report also proposes exploring new guidelines to limit direct advertising of unhealthy foods to children, aiming to address misleading marketing practices.

It recommends that the Department of Health and Human Services and Department of Agriculture work with restaurants to increase education and awareness of age-appropriate healthy food options for children.

"The topics on which (Kennedy) wishes to work are not the major causes of chronic disease and many of those are essentially missing from the report (tobacco, alcohol, sodium, added sugars reduction)," Peter Lurie, president of the Center for Science in the Public Interest, told Reuters ahead of its publication.

Industry groups had also pushed back against the contents of the earlier report.

More than 250 groups representing farmers, ranchers, and agrochemical companies called for greater input into MAHA Commission activities following the release of the first report. The White House responded by holding meetings with food and farm groups over the summer.

Kennedy said during a Senate hearing last week that HHS had met with 140 farm interests in the past three months.

"We're consulting every stakeholder in the farm community in everything that we do," he said.

FOCUS ON NUTRITION NOT REGULATION 

The report focuses more on nutrition and lifestyle adjustments rather than tightening regulations, and suggests loosening water discharge and other pollution standards for some meat processing plants and farms. 

Among the policy proposals in the report are the establishment of a National Institutes of Health Chronic Disease Task Force, a government definition for "ultra-processed food," and restrictions on synthetic food dyes, which the May report said were potentially linked to autism, without evidence.

It also calls for additional research into vaccine safety, a contentious area given Kennedy's past promotion of debunked claims linking vaccines to autism.

The EPA should work with the Agriculture Department to promote precision pesticide application, the report said, with the aim of reducing overall use, but stopped short of recommending regulatory action.

The EPA, USDA, and NIH should collaborate on a framework to study cumulative chemical exposures, the report said, including pesticides. It recommends that research use advanced methodologies that employ human-relevant models.

Pesticide use has exposed a growing rift between MAHA activists and Republican politicians closely tied to the agriculture industry.

In August, hundreds of activists sent a letter to the White House opposing a congressional proposal that would shield pesticide and "forever chemical" manufacturers from lawsuits.