March 2009 Archives

I often listen to Lynne Rosetto Kasper's radio show The Splendid Table on Sunday afternoons. She offers an eclectic mix of travelogues, food history, recipes, music and other features. Today, poet Jane Hirshfield read some of her work and made the interesting observation that successful restaurants sometimes grow up around people getting together to eat for a particular reason. She gave three examples (all in Northern California, as it happens). Chez Panisse began in 1971 with Alice Waters cooking dinner for a group of friends who wanted to talk politics on a regular basis. The Delancey Street Restaurant was created in 1991 as a place for people in the Delancey Street Foundation residential rehabilitation program to do meaningful work. And the pioneering vegetarian restaurant Greens was established in 1979 by a Zen monastery as a place where students could extend their practice of Buddhism into the workplace.

Hirshfield's observations made me stop and think about the way cooking and eating can act as the "glue" bringing people together and facilitating pursuits like political debate, social change and spirituality. When we as nutrition professionals promote good health by trying to influence people's behavior and relationship to food, we need to keep in mind that food is a lot more than nutrition for the body. It's also feeds the soul.

On March 27, the Wall Street Journal and other media outlets reported on the work of the Health Reform Dialogue, a coalition of hospitals, insurers, employers, physicians, pharmaceutical companies, advocates and consumer groups. While each of these entities has its own position on health care reform, this "conversation" among them, which took place over a period of 6 months, was the first time they had explored their common ground.
Organizations that participated in the Health Reform Dialogue include: AARP, Advanced Medical Technology Association, America's Health Insurance Plans, American Cancer Society Cancer Action Network, American College of Physicians, American Hospital Association, American Medical Association, American Nurses Association, American Public Health Association, Blue Cross and Blue Shield Association, Business Roundtable, Catholic Health Association of the United States, Families USA, Federation of American Hospitals, Healthcare Leadership Council, National Federation of Independent Business, Pharmaceutical Research and Manufacturers of America, and the U.S. Chamber of Commerce.

In a report published last week, the group called for a paradigm shift to focus attention and resources on wellness and prevention and on primary care:

Marty Yadrick, MS, MBA, RD, FADA, the president of the American Dietetic Association (ADA) testified on March 26, at a Congressional hearing on the state of obesity in the United States. This hearing - which was the first of the year for the House Agriculture Committee Subcommittee on Department Operations, Oversight, Nutrition, and Forestry - left no doubt that nutrition is no longer a back-burner issue in Washington, DC.

Marty made a number of powerful observations. I've extracted five points from his testimony and recommend them as talking points for anyone building a case for the critical role of nutrition plays in disease prevention and health promotion.

In 1993, during my term as president of the American Dietetic Association (ADA), the Clinton Administration's health care reform effort was the talk of the nation. The centerpiece of ADA's public policy initiative that year was securing reimbursement for medical nutrition therapy - that is, the treatment of an existing disease or condition with nutrition protocols.

Early on, the Clinton plan focused on prevention as the key to cost savings. Of course, as registered dietitians, we knew full well that the disease prevention and health promotion impact of nutrition begins far upstream, long before an illness has taken hold. But the country was not yet ready to embrace that kind of thinking. So ADA zeroed in on the healing power of good nutrition and wrapped that message in a medical context that the public - and lawmakers - could understand and accept. Nutrition support teams sprung up in hospitals around the country, and the status of dietitians rose as they became full-fledge members of interdisciplinary care teams.

Fast-forward 16 years. Health care reform is once again at the top of the nation's policy agenda - and we are in a whole new ball game. Whereas 16 years ago, consumers may have thought free radicals and probiotics were something left over from the 1960's, they now understand that nutrients interact with each other and with the cells of the body not only to treat disease and speed healing but also to prevent disease and lower health care costs. The proliferation of foods carrying health claims, dietary supplements and nutraceuticals demonstrate a cultural shift in the way the public perceives food. Today, food is medicine - preventive medicine.

My Fleishman-Hillard colleague and master blogger, Mark Senak, posted a most informative and discerning food safety-related blog this morning titled "Taking the F out of FDA." I strongly recommend that you take a moment to read his analysis of the Food and Drug Administration's current situation and possible future. Mark has written an excellent briefing and supplies links to insightful reporting from the New York Times as well as video of the weekly address in which President Obama outlined his food safety overhaul plan.

I'll add one more link - to an April 2 the New England Journal of Medicine editorial "A To-Do Lit for the New FDA Commissioner." This piece concludes: "By restoring science to its rightful status, by forcefully advocating for needed resources, and by improving the FDA's record as a guardian of public health, the new commissioner will most effectively serve the American people."

Have you ever hosted a high-powered event and neglected to invite someone - someone really, really key? Someone who would bring a lot to the party - knowledge, experience, commitment and passion? Someone you'd spoken highly of in the past? Someone who could be a big help to you in the future?

Ooops! It looks like President Obama recently did exactly that when he didn't include a representative from the American Dietetic Association (ADA) - the world's largest organization of nutrition professionals - in the March 5 White House Forum on Health Reform.

I was following along that day on C-Span and the White House blog and heard the President say, "Our goal will be to enact comprehensive health reform by the end of this year."

During the past couple of weeks, two high-powered partnerships announced plans to attack the nation's obesity crisis. Their approaches differ, but here's what both have in common: They are building bridges where little if any stable, strong connection existed before. I am referring to the Alliance for a Healthier Generation Healthcare Initiative and the National Collaborative on Childhood Obesity Research.

The Alliance Health Care Initiative (ANI) is a joint effort of the American Heart Association and the William J. Clinton Foundation with assistance from the American Academy of Pediatrics and the American Dietetic Association. ANI is the first coordinated national effort by national health associations, leading insurers and employers to offer health benefits to prevent, assess and treat childhood obesity. Thanks to the bridges built by ANI, children and families throughout the country will have access through their physicians to nutrition therapy services provided by registered dietitians. (Kudos to Pepsico, one of the country's largest food companies, for participating in the program.)

Reduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize.

This is the conclusion reached by Fred M. Sacks, MD, et al. in "Comparison of Weight-Loss Diets with Different Compositions of Fat, Protein and Carbohydrates," published in the February 26 New England Journal of Medicine. In other words, if you want to lose weight, you have to expend more energy than you consume. Not surprisingly, results from this Harvard­-Louisiana State­-National Heart, Lung and Blood Institute study made national headlines. And I suspect the American public felt some relief in hearing reliable confirmation of the fact that no matter what diet you choose, it's the calories that count.

Looking at this study from the viewpoint of nutrition practitioners and food and beverage marketers, I think the authors' remarks at the end of the article hold some key take-away messages. I quote a portion of these remarks here (emphasis mine):
Divergent results [from previous studies] suggest that any type of diet, when taught for the purpose of weight loss with enthusiasm and persistence, can be effective. ... Diets that are successful in causing weight loss can emphasize a range of fat, protein, and carbohydrate compositions that have beneficial effects on risk factors for cardiovascular disease and diabetes. Such diets can also be tailored to individual patients on the basis of their personal and cultural preferences and may therefore have the best chance for long-term success.