DRAFT: This module has unpublished changes.

Janine Logan   HFN503  2015  Dietary Guidelines Assignment         July 6, 2016

 

Healthy Eating Is all in a Day’s Choices

 

      The 2015 Dietary Guidelines promulgated by the United States Departments of Agriculture and Health and Human Services speak to healthcare practitioners, policymakers, and the American public in a novel way.  The guidelines provide for flexibility in food choices that allow for consideration of consumption of some foods that fall outside otherwise prescriptive parameters, while repetitively reminding us that such deviation is accepted as long as we remain under recommended calories and gram intake.  Such taboo substances, like sugar and even transfat, make the short list.  Throughout the guidelines, we are cleverly reminded to choose nutrient-dense, low-fat, high-fiber, low sugar foods that the experts know will lead to satiety and meet calorie counts, thereby inherently negating our desire for sweets, high fats, and empty calorie foods.  Could we have our cake and eat it too?  Not exactly, but the guidelines’ messaging is smartly crafted to allow us to think we can and, indeed, some of us can, if there is room left in daily allowable calorie intake.  This flexible, non-authoritarian approach to food choices is what makes this edition of the U.S. Dietary Guidelines successful. 

     That flexibility is embodied in the healthy eating pattern approach that is the central theme of the 2015 guidelines.  This approach recognizes that foods are not consumed in isolation and that focusing on everything we eat and drink in a day is more natural.  The U.S. Departments of Agriculture and Health and Human Services secretaries’ message sums it up best when it states, “[This edition] recommends where shifts are encouraged to help people achieve healthy eating patterns.  These analyses will assist professionals and policymakers as they use the Dietary Guidelines to help Americans adopt healthier eating patterns and make healthy choices in their daily lives, while enjoying food and personal traditions through food.”   This is a realistic goal.

Chronic Disease Link

     The guidelines draw from a wide body of nutrition science research.   Results from various studies conclude that strong evidence exists that shows that healthy eating patterns are associated with a reduced risk of chronic diseases, especially cardiovascular disease, and overall positive health outcomes.  The link between dietary patterns and chronic diseases is an important emphasis noted throughout the guidelines.  The epidemic of overweight and obese adults and children has not abated, even though Dietary Guidelines have been in place since 1980. Previous editions of the Dietary Guidelines looked at the body of evidence that examined the relationship between individual foods, food groups, and nutrients and their effect on health outcomes and chronic diseases. The 2015 guidelines take this evidence one step further and incorporate research that informs the relationship between whole diet and chronic diseases.  In chapter one, which examines the science behind healthy eating patterns, it notes, “… dietary components of an eating pattern can have interactive, synergistic, and potentially cumulative relationships, such that the eating pattern may be more predictive of overall health status and disease risk than individual foods or nutrients.”  Nutritionists, medical professionals, and policymakers will be watching the results, no doubt, of these revised recommendations to see if the current prevalence of chronic disease among adults – now affecting about one in every two adults[1] – dips.  It is questionable whether a mere five years would result in any appreciable difference, but there is hope that these guidelines, with their adaptability focus may do the trick.

Community Approach

     The last of the five guidelines – support healthy eating patterns for all – may very well tip the scales toward compliance and adoption of healthier eating habits.  The Dietary Guidelines Advisory Committee (DGAC) was wise to include guidance that achieving healthy eating patterns cannot happen alone and that if Americans are to meet the recommended intake of necessary nutrients then it must be a collective effort.  “Everyone has a role in helping individuals shift their everyday food, beverage, and physical activity choices to align with the Dietary Guidelines,” states the introduction in chapter 3.  This is good common sense advice, as no one lives in isolation.  We are making food choices where we work, go to school, in places where we congregate to practice our faiths, at venues we visit for entertainment and sport, and at local civic and community gatherings.  Without collaboration, our individual efforts to choose healthy foods fall prey to sabotage when we are outside the confines of our homes. 

     Additionally, with multiple sectors of society committed to utilizing the 2015 Dietary Guidelines, there is increased likelihood that more individuals will get on board and a positive effect upon the broader population will result.  This is the concept behind the well-known health pyramid[2] developed by public health leader and current director of the Centers for Disease Control and Prevention Dr. Thomas Friedan. The model holds that we have the greatest chance for broad success of health interventions at the base of the pyramid where multiple sectors of society reside – governments, businesses, schools, workplaces, community groups. 

     The Dietary Guidelines’ social-ecological model for food and physical activity decisions aligns well with the health pyramid.  In the guidelines’ Strategies for Action section found in chapter 3 it states, “Evidence demonstrates that multiple changes both within and across all levels of the social-ecological model are needed to increase the effectiveness of interventions.”  These changes may include nutrition policy updates at schools, local governments’ funding of community gardens, and a variety of private-public partnerships that increase access to affordable, nutritious foods, especially in low-income and food desert areas. The social-ecological model considers the broader community and environment’s influence on behavior.  This approach accepts that behavior change occurs on multiple levels and with the support of multiple partners.[3]

 

      Efforts to enhance affordability and access are an important consideration contained in the 2015 Dietary Guidelines.  In keeping with the tenets of a social-ecological model, the guidelines examine the “contextual” factors that affect healthy eating patterns and how nutritionists, policymakers, and medical professionals must consider these factors when developing strategies and education to promote alignment with a healthy eating pattern. These factors include income, education level, and transportation access to name a few.  These factors are similarly well-known as the social determinants of health among public health experts. 

Improvements

    The major improvement in the 2015 guidelines vs. the 2010 guidelines is the way in which the call to action is framed.  From the start, the 2015 guidelines emphasize an integrated healthy eating pattern approach that takes into account all the foods and beverages consumed in a day, while the 2010 document version lists building a healthy eating pattern as the last key recommendation.  Indeed, within the three terms to know call out boxes, calorie balance is replaced with variety, suggesting a more attainable approach to ensuring that foods from all groups are consumed naturally, which leads to appropriate caloric balance.  The 2010 edition starts with calorie counting advice followed by what foods to reduce and then what foods to increase.  The 2015 guidelines’ pervasive healthy eating pattern focus allows for adaptability and flexibility and, as behavioral science research has shown, when less restriction and choice is presented there is enhanced compliance.

     It is also helpful and an improvement that the 2015 version adds the more consumer-friendly Healthy Mediterranean-Style Eating Pattern as another option.  The Mediterranean-Style Eating Pattern is supported by extensive research that was reported in the 2010 edition of the guidelines.[4]  Studies have consistently found that there is a lower incidence of cardiovascular disease risk among those who follow a Mediterranean Style Eating Pattern, which de-emphasizes meat consumption and emphasizes vegetables, fruits, nuts, olive oil, and whole grains.

     The elapse of five years allows for more study of the nutrition and food science available and an in-depth review of cutting-edge research.  It’s a natural progression that each subsequent edition of the guidelines would benefit from more accumulated and newer research, and the 2015 guidelines are no exception.  The 2015 guidelines used a systematic review of methodology to analyze relevant studies and the advisory committee benefited from five years’ of studies that emanated from the USDA’s Nutrition Evidence Library (NEL), which was only created in 2010.  In the current guidelines’ section explaining the scientific review process it states, “Very few existing nutrition-focused systematic reviews were available for the 2010 Advisory Committee to use.  Since that time, systematic reviews in the nutrition field have become common practice.  Therefore, unlike the 2010 Advisory Committee, the 2015 Advisory Committee was able to use existing reviews to answer many of its research questions.”

Unfortunate Omission

     The decision to eliminate the recommendation that adults should limit their consumption of cholesterol to 300 mg a day is a mistake.   The 2015 Advisory Council reasons that because healthy eating patterns promoted in the new guidelines are low in saturated fats and thus low in cholesterol, the patterns themselves inherently reduce cholesterol consumption.  It becomes a situation of out of sight, out of mind and runs the risk of consumers’ misinterpreting the omission.  Although the guidelines advise that the omission does not suggest that “dietary cholesterol is no longer important to consider when building healthy eating patterns” consumers are likely to assume it is less important.  Further, the committee notes that the current average intake of dietary cholesterol is 270 mg per day.  This average leans toward the high end near 300 mg and does not represent an appreciable enough decrease to eliminate it from the guidelines.  It certainly does not hurt to include the limit in the 2015 edition.

     Dr. Robert Lustig, the well-known endocrinologist studying childhood obesity, in his You Tube presentation, which is part of the Nutrition in the Media course curriculum offered by Stony Brook University, illustrates the metabolic process by which high-fructose corn syrup travels quickly and directly to the liver where it is converted to fat.  Some of this fat enters the bloodstream as low-density lipoprotein (LDL), which leads to high-cholesterol and cardiovascular disease. Lustig puts it quite simply when he states, “When you consume fructose, you really consume fat.”   Since we are aware that the American diet contains more sugar than we need, most of it in hidden forms, then it does not make sense to remove the cholesterol limit. 

Consumer Education and Practical Guidance

     The 2015 Dietary Guidelines are developed for use by nutritionists, policymakers, medical professionals and other health professionals and are not meant, on face value, for the general public.  Rather, these professionals are charged with studying the guidelines and using their judgement to provide the right nutrition advice to patients and consumers.  In this regard, the Strategies for Action noted in chapter 3 provide a loose framework for how professionals can incorporate the guidelines into programs and educational opportunities across multiple sectors.  The guidelines also feature the MyPlate graphic tool developed by the federal government and released in June 2011.  Supporting documents and consumer resources for professionals are available at the MyPlate.gov website.[5]  However, for ease of reference, it might have been useful to include a few samples of those tools in the guidelines.  The 2015 Dietary Guidelines achieve a fairly adequate job of consumer education and policy-into-practice recommendations.  

Public Oral Comment Session

     The 2015 Dietary Guidelines were informed by an extensive review of nutrition science research and studies and written and oral comments from special interest groups, federal experts, and the general public.  As such, we must be mindful of the level of objectivity members of the DGAC can maintain.  The range of special interest groups representing a variety of food manufacturers, producers, and retailers who commented during the March 24, 2015 public meeting[6] on the scientific report of the 2015 DGAC confirms the very challenging task the committee faced.  Commentators ranged from a scientist at the Tea Council of the USA who suggested listing tea as a water hydration option to a representative from the Sugar Association who advocated that small occasional treats be part of the American diet.  Fortunately, the 2015 Dietary Guidelines did not consider the latter suggestion. 

Summary

     The 2015 Dietary Guidelines is an impressive document that pulls a tremendous amount of scientific research and data and empirical evidence together and maps it into a logical blueprint for professionals to follow.  The healthy eating pattern approach does a good job of describing how Americans can easily ensure they consume a variety of nutrients and foods from across the essential six food groups, and more importantly, why such a pattern is important to overall health.


[1]Chronic Disease Prevention and Health Promotion. Chronic Diseases Overview. http://www.cdc.gov/chronicdisease/overview/index.htm Updated February 23, 2016.  Accessed July 3, 2016.

[2]Frieden T. “A Framework for Public Health Action: The Health Impact Pyramid.” American Journal of Public Health. April 2010:100 (4):590-595. Print.

[3] U.S. Department of Health and Human Services. Physical Activity and Health: A Report of the

Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion.  p. 214.

[4] Dietary Guidelines for Americans 2010.  U.S. Departments of Agriculture and Health and Human Services.  http://health.gov/dietaryguidelines/dga2010/DietaryGuidelines2010.pdf   Published December 2010.  Accessed July 3, 2016.

 

[5] USDA ChooseMyPlate.gov.  http://www.choosemyplate.gov/  Accessed July 3, 2016.

[6] Office of Disease Prevention and Health Promotion.  Public Meeting for Oral Testimony on the Scientific Report of the 2015 Dietary Guidelines Committee.  http://health.gov/dietaryguidelines/2015/public-meeting.asp Webcast. March 24, 2016. Accessed July 4, 2016.

DRAFT: This module has unpublished changes.