simplistic nutrition recommendations: unintended consequences
DESCRIPTION
I delivered this presentation to the Diablo Valley Dietetic Association January 20, 2010TRANSCRIPT
Simplistic Nutrition Recommendations: Unintended Consequences
Maureen Bligh, MA, RDJanuary 20, 2010
Outline Background Recent research on consumer
attitude & behaviors Role of food grouping system Role of nutrient-rich foods Nutrition education application tips Summary and action steps
Background: Common Simple Messages
Clean your plate
No Pain No Gain
A sun tan is a sign of good health
Starve a cold, feed a fever
If a little is good, then
more is better
Background: Common Messages
Eat more fruits and veggies
Avoid fat and sugar
Use sunscreen
Limit your fat intake
Exercise!
N Engl J Med. 1997 Apr 17;336(16):1117-24.
Examples of simplistic recommendations and outcomes Dietary Guidelines “Choose Low-fat
foods”▪ Gave unintended permission to
consume more low- fat foods which are not always lower in calories
1971 - 2000▪ % kcal/fat reduced▪ Total kcal increased▪ Total gm fat increased
Examples of simplistic recommendations and outcomes (cont.) Weight loss diet Bone
loss Vegetarian Nutrient
deficiencies Low-carb Nutrient
deficiencies and chronic disease
Sugar Avoid some nutrient-rich foods
Am J Clin Nutr 2007 Apr;85(4):972-80 www.dairycouncilofca.org/PDFs/Unintended-consequences.pdf
More examples Diabetic kids may focus too much on
carb counting▪ December Diabetes Care
Consumers Stress over Organic Eating ▪ Blog post on eatright.org
Other examples?
Foods versus SupplementsUnintended consequences can also result from
overuse of supplements: Overdosing on single nutrients Nutrient deficiencies secondary to
imbalanced ratio of supplemental nutrients Overlooking non-nutritive components in
foods
JADA 2005:105(8):1300-1311
Possible outcomes of nutrition legislation and regulations
Legislated solutions for school food service and school vending
Banning or limiting certain foods perception that those foods should always be avoided e.g. pizza, flavored milk
Allowed foods diet soda, engineered donuts and toaster
pastries; are these “healthy”?
Nutrition and You: Trends 2008 67% of consumers said diet, nutrition
and physical activity are “very important” to them personally.
40% of people strongly agreed with the statement: I actively seek information about nutrition and healthy eating
www.eatright.org/trends2008
Nutrition and You: Trends 2008 The most popular sources of food and
nutrition information were TV (63%) and magazines (45%), followed by the internet.
Dietitians, nutritionists, doctors and nurses were ranked as the most credible
www.eatright.org/trends2008
Nutrition and You: Trends 2008 54% of people think there are foods that
they should never eat. 38% strongly agree that they are always
hearing information about what NOT to eat, rather than what they SHOULD eat.
www.eatright.org/trends2008
International Food & Information Council Consumer Survey
>60% believe that certain foods and beverages can provide multiple health benefits
>80% say they are consuming, or would be interested in consuming, foods and/or beverages for such benefits.
http://www.ific.org/research/foodandhealthsurvey.cfm
Food Guidance Systems:Old-school tools can still solve new-
age problems
History of USDA’s Food Guidance
1940s
1950s-1960s
1970s
1992
2005
Food for Young
Children
1916
Guiding Principles— Unchanged
Overall Health
Up-to-Date Research
Total Diet
Useful Realistic
Flexible Practical
Evolutionary
MyPyramid Recommendations Compared to Consumption
-100
0
100
200
Perc
ent c
hang
e
Females 31-50 Males 31-50
Increases
Current Intake
Decreases
Fruits Vegetables Grains Meat & Beans Milk
Bars show percent change needed in consumption to meet recommendations
Diets skewing food-grouping approachSimplified diets are often based on limiting or
omitting foods from a certain food group to reduce calorie intakes
Low-carb diets limit breads, grains & cereals and fruit group
Vegetarian diets reduce intake from meat, beans and nut group, and sometimes dairy group
High protein diets increase intake from meat, beans and nut group, to the possible detriment of intake from other groups
Many diets limit or omit dairy based on the false presumption that dairy foods are fattening.
Unintended consequences of limiting food groupsDiet Nutrient
implicationsPossible long-term
health consequences
Low dairy Low in calcium, magnesium, potassium, riboflavin, Vit B6, B12, A, D
FracturesOsteoporosis Higher risk of hyper-tension & colon cancer
Low carb Low in whole grains, fiber, B-vitamins, folate
Heart diseaseConstipationDiverticulosis Neural tube defects
High protein Low in carbohydrates, fiberHigh in saturated fat
Heart diseaseDiabetesStrokeCancer
Choose nutrient-rich foods from all food groupsThe nutrient-rich food categories are aligned with
the Dietary Guideline's definition of a "healthy diet" and MyPyramid's five food groups, and include:
Brightly colored fruits and 100% fruit juices Vibrantly colored vegetables and potatoes Whole, fortified and fiber-rich grain foods Low-fat and fat-free milk, cheese and yogurt Lean meat, poultry, fish, eggs, beans and nuts
Nutrient-Rich Foods Coalition Partnership that brings together leading
scientific researchers, communications experts and agricultural commodities
Dedicated to advancing scientific and market research to develop tools to help people understand and incorporate nutrient-dense foods into their healthy lifestyle.
Supports the 2005 Dietary Guidelines for Americans and MyPyramid
www.nutrientrichfoods.org
NRFC website Recipes and meal ideas Navigating the grocery
store Nutrient-rich shopping list Guide to nutrition labels Portion control basics Adding nutrients to meals Eating out Fitting in “fun” foods
www.nutrientrichfoods.org
New considerations: Front of Package (FOP) Labeling
Front of Package (FOP) LabelingPros
▪ Consumers want a simple, easy to use system and quick guidance.
▪ Ease of comparing similar food products (e.g. cereals, snack foods)
Front of Package (FOP) Labeling
Cons▪ Systems encourage good food – bad
food perceptions among consumers▪ Does not allow for individualization▪ Some nutrient-rich foods may
receive low ratings e.g. nuts, cheese, meats.
What to look for in a FOP label?Is the scoring or program-nutrient criteria: Publicly available or published in scientific
journals? Objective and balanced between positive and
negative nutrients? Scientifically representative of consensus
dietary guidance—2005 Dietary Guidelines for Americans and MyPyramid
Is it flexible to accommodate changes anticipated with the 2010 revision of the Dietary Guidelines?
What to look for in a FOP label? Are there additional program support tools
such as websites, in-store cooking classes, tours, and other education programs to help consumers understand the use of specific foods in planning meals and in the total diet?
Can the program information be transferred to other settings when food choices are made outside the supermarket?
Optimal Diet
Genetics &Ethnicity
Preferences,Aversions,
Intolerances
Social,Cultural,
Religious Factors
Lifestyle &Environmental
Factors
Smoking
Age & Gender
Disease risk
Activity level
Individualizing nutrition advice
Individualization in nutrition advice: Role of health professionals
Help clients prioritize their health goals Identify specific and realistic measures to
accomplish those goals Use the food guide system as the basis for
forming a sustainable, healthy eating plan▪ Flexible enough to accommodate a wide range
of goals and health concerns▪ Ensures adequate intake of individual nutrients
Total Diet ApproachFocus on…… Instead of…. Total intake of foods Emphasis on nutrientsDietary patterns, e.g. MyPyramid or DASH Diet
Single-foods approach
Healthy diet over time Good versus bad foodsHealthy eating pattern + supplements
Over-reliance on supplements
Goals of Nutrition Education To encourage a balanced, individualized
diet that includes adequate amounts and variety of foods from all food groups
To dispel the “good” and “bad” foods perspective
To discourage extreme dietary restrictions
Small steps that lead to long-term compliance
Venues for Nutrition Education
Need to embrace new venues to reach today’s consumer:
Internet Websites Listservs Electronic newsletters Wellness centers
Application Tips for the Practicing Health Professional Look at the ‘big picture’ of dietary
advice; Strike the right balance between info overload and simplicity
Include recommendations for all food groups – with action steps for priority issues
Encourage foods first
Application Tips (cont) Take an individualized approach to
health Consider how to reach a broad range
of consumers with balanced dietary messages
Give them more credit; don’t “under-sell” clients with nutrition information
Application Tips (cont) Embrace newer research and
knowledge once validated Be open to shifting paradigms &
pass that along to clients.
Actionable Recommendations Avoid vague
recommendations such as “Eat less salt”
More specific is better – determine cooking skills, food preferences to develop specific action plan
Develop plan that will make most difference
Case Study Case study: 70 year old women, 5’5” and
weighs 165 lbs. She has type 2 diabetes. She is on “diet only” therapy and has been told in the past by her doctor to cut out sweets and eat more fruits and vegetables. After 6 months her weight is essentially unchanged and her hemoglobin A1C is about the same. Her doctor starts her on oral diabetes medication and she is referred to a dietitian.
What are the possible unintended consequences of the dietary advice given to this woman?
What was missing in the doctor’s initial treatment plan? Diet History: caloric intake is adequate to maintain her current weight. She has cut out sweets as her doctor instructed but consumes several glasses of fruit juice per day. You also discover her vegetable and dairy intake is low.
Resources
These tools can help you get the right balance between nutrition complexity and accuracy:
MyPyramid Menu Planner MyPyramid Food Tracking Worksheets Eat Smart. Play Hard. Healthy Lifestyle Personal Nutrition Planner
Resources (cont.)Nutrition and You: Trends 2008. ADA
www.eatright.org/trends2008
2008 Food and Health Survey: Consumer Attitudes toward Food, Nutrition & Health (IFIC). http://www.ific.org/research/foodandhealthsurvey.cfm
Summary Simplistic dietary recommendations can
easily lead to unintended health consequences.
Before adopting dietary change, examine the overall impact it will have, particularly on long-term health and wellness.
A food grouping system such as MyPyramid should form the basis for a balanced diet that can be sustained over the long term.
Choosing nutrient-dense foods from all food groups is the best way to optimize nutrient intakes while keeping calorie intake in check.