April 2011 Archives

I just finished preparing a presentation for the California Dietetic Association. The National Cattlemen's Beef Association asked me to talk about the where the profession is headed in the future. I had to think very hard about what to say to a state association that has a history of producing so many of the profession's leaders.

I have spoken on this topic often in my career, but I think now is the time to take a deeper dive into what I see happening in food and nutrition. What must RDs do to have an impact on health and wellness in the decades to come? What can I tell my audience that they don't already know or haven't heard many times before? Should I share trend information, graphs and statistics? I thought not

I began to think of words we frequently use - for example, "food and nutrition expert." Well, today, everyone is a food and nutrition expert (or thinks they are). As is the case in many professions, dietetics faces a crisis in authority. Who is the respected, trusted, authentic, go-to food and nutrition authority?  What must the audience members listening to my presentation do to be unequivocally recognized as the food and nutrition expert?

I decided to discuss what I believe are imperatives for the dietetics profession: We must demonstrate value, examine our business models, collaborate strategically and communicate passionately as we take on the big issues that demand innovation and fuel a burgeoning national wellness movement. RDs can - and must - create this momentum.

To help illustrate my views on this topic, I drew inspiration from leaders of the past - going back to early scientists, women activists and even major reformers who served in the military. And I looked for synergy with other disciplines such as medicine, sociology, psychology and economics.

In future blogs, I will elaborate on these points, but right now, I wanted to begin sharing my readings with you. These are not sources dietitians would typically review, but taking a broad look at the world - past and present - is absolutely necessary if we are to make our mark on the future.

Meals to Come: A History of the Future of Food by Warren Belasco. University of California Press, 2006

"The Politics of Nutrition in North America," by Harvey Levenstein. Neuroscience and Behavioral Reviews. 1996. 26(1):75-78

Revolution at the Table: The Transformation of the American Diet by Harvey Levenstein. University of California Press, 2003

The Authenticity Hoax: How We Get Lost Finding Ourselves by Andrew Potter. Harper, 2010

The Wisdom of Crowds by James Surowiecki. Anchor, 2005

Wikinomics: How Mass Collaboration Changes Everything by Don Tapscott and Anthony D. Williams. Portfolio Trade, 2010

From Home Sister to Second Lieutenant: Army Dietitians in World Wars I and II by Patricia A.M. Hodges. Catawba Publishing, 2007

Government guidelines recommend that Americans lower calories, sodium and fat and increase fiber, calcium and other shortfall nutrients. These recommendations are often interpreted to mean "stay away from processed foods" - foods that are canned, frozen or packaged. Consumers rarely hear about the benefits of food processing. They are left with the belief that people who are committed to health eat only fresh foods - and, even more extreme, only locally grown fresh foods.

But let's think about our lifestyles. Is it realistic to eat this way? Is it essential to eat only fresh whole foods to be healthy? Availability, affordability, quality and safety issues add up to only one answer: No.

In fact, it would be far more beneficial to the consumer to abandon this binary good vs. bad point of view in favor of a complementary perspective. A century of transformative advances made in food science and technology allow us to produce an array of safe, nutritious, flavorful, convenient, cost-efficient foods. Working in tandem, processed and non-processed foods provide consumers a full range of choices.

Although they are rarely discussed in a positive light, food processing and packaging have clearly definable benefits for consumers:

·         Safety - Food processing removes health hazards associated with microbial pathogens. Processing operations dealing with raw food materials or ingredients carrying pathogens have significant controls and regulations to detect and inactivate food-borne microorganisms that can cause illness.

·         Quality - Food processing allows quality improvements to be made in a predictable and controlled way. Some processed products, such as canned and frozen fruits and vegetables, are often a better value than their raw counterparts and are available all year. For example:

·         Health and Wellness - Because of consumer demand for foods that promote health and wellness, manufacturers process foods to be low in calories, fat, sugar and salt and high in fiber to help people with chronic conditions such as heart disease, diabetes and hypertension.

In addition, without food processing, it would not be possible to meet the needs of contemporary urban populations in this country and around the world. These needs will grow only greater with time. Research confirms that people living on a low income have a less varied diet and thus poorer nutrient intake. Fortifying products and preserving nutrients through processes such as freezing enables those without access to a wide range of foods to gain better nutrition from the narrower range of foods available to them.

The bottom line for nutrition professionals: More information about modern food production methods and benefits is needed to help consumers make truly informed food choices from the wide variety of fresh and processed foods in today's marketplace.

Want to learn more? Here are some excellent resources that give you the whole story
on processed foods.

Institute of Food Technologists

Feeding the World Today and Tomorrow: The Importance of Food Science and Technology

International Food Information Council

Understanding Our Food Communications Tool Kit

This past week, I was on an educational trip to Argentina with the American Dietetic Association's Food & Culinary Professionals practice group. There were few emails and no cell phones, which allowed me to think and to observe more than I might have if I had been distracted by technology.

Argentina is known for its beef, which is grass fed. But that's not the only difference: There is no such thing as a tender and less tender or low-fat cuts. The locals say that the average Argentinean consumes 160 lbs. of beef each year. Heart disease is a major cause of death in Argentina, as it is in the U.S. In fact, the inventor of the stent is from Buenos Aires.

I was struck by how difficult it would be to change behavior and get Argentinians to eat differently. They seem to know that their high fat intake is not good for their health. Yet there appears to be little interest in changing eating habits.

While relaxing one afternoon in Buenos Aires, I glanced through the previous week's New York Times Magazine and was fascinated with an article questioning whether the Mediterranean diet really exists. Nutrition professionals extol the virtues of eating a plant-based diet high in whole grains and fruits and vegetables, but do people living in the Mediterranean region really eat this way? It's doubtful and, by the way, 75% of the Greek population is overweight. Sound familiar?

Clearly, nutrition professionals worldwide are challenged to help people eat to make wise food choices. No one food is the culprit, and extreme strategies like special taxes on certain foods are not the answer. We need to be mindful of the approach/steps communications firms use to develop campaigns and advertisements - awareness, interest, engaging a commitment to change, finally, action. I think we may be at step two - interest. Behavior change is a long way off, but we must continue to work toward that goal.

"Food processing is a fundamental aspect of human culture and industrial methods are necessary to support a world population that now exceeds 6 billion. Extensively processed foods like refined flour, sugar, and oils have been consumed by humans for millennia as ingredients in meals made primarily from whole or minimally processed foods. The problem . . . is the creation of a dietary pattern based on factory-made, durable, hyperpalatable, aggressively marketed, ready-to-eat or heat foodstuffs composed of inexpensive, highly processed ingredients and additives." [emphasis mine]

This passage is from an April 7, 2011, Journal of the American Medical Association commentary titled "Technology, Diet and the Burden of Chronic Disease" by David S. Ludwig, MD, PhD, Children's Hospital of Boston.

I think this short article presents one of the most reasonable positions on processed foods that I have seen to date. Dr. Ludwig walks us through three revolutions in food technology: the use of stone tools and fire for cooking, the Agricultural Revolution and the Industrial Revolution, culminated in today's "ultraprocessed foods."

But then he reminds us that "extensively processed foods like refined flour, sugar, and oils have been consumed by humans for millennia as ingredients" and that ultraprocessed foods become a problem when our dietary pattern is based on them. To me, this position says "balance, variety and moderation" - which has long been the mantra of nutrition professionals. As we move through the national conversation on processed foods, let's remember the strength and value these three little words.

In mid-March, the Institute of Medicine (IOM) released a report (click here to read) from its November 2010 workshop titled "Understanding the Relationship Between Food Insecurity and Obesity." And a complicated relationship it is: How can more than two-thirds of American adults and one in three American kids and teens be overweight or obese when food insecurity is one of the most important public health threats the country? According the Economic Research Service, 14.7% of households were food insecure at least some time during 2009 -- the highest recorded prevalence rate of food insecurity since 1995 when the first national food security survey was conducted.

Because of today's high unemployment, one in four U.S. kids now lives in a household that sometimes runs out of food. Currently, USDA food programs serve about one in four people in the United States. In August 2010, the Supplemental Nutrition Assistance Program (SNAP), formerly known as the Food Stamp Program, reached more than 42 million people. In addition, more than 31 million children participated in the National School Lunch Program, with two-thirds of them receiving a free or reduced-price meal, and more than 9 million people participated in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC).

The IOM workshop sought to "to understand the relationship between food insecurity and obesity in the low-income populations that nutrition assistance programs are designed to serve in an effort to help identify a research agenda [to]

Increase . . . understanding of their coexistence."  In other words, if people don't have enough food, why are they gaining excessive weight?

Further complicating the picture is the fact that some households below the poverty level are not food insecure, and some households well above the poverty line are food insecure. Life events such as a job loss or divorce that are not captured in annual income measures can affect a household's food security status. Some households experience food insecurity episodically, even though their annual incomes are well above the poverty line

While I don't have an answer to food insecurity-obesity puzzle, I do know that dietitians must play a key role in uncovering how this seemingly contradictory relationship works. As the IOM report points out, food insecurity has a nutritional component: the compromise between food quality and food quantity. Nutrient-dense foods are generally more expensive than energy-dense foods.

I commend IOM for the interdisciplinary model it used to explore this issue - creating dialogue among people who probably would not be collaborating on a regular basis: specialists focused on hunger, specialists focused on overweight/obesity, academics, activists, and qualitative and quantitative researchers. And I believe that unraveling the food insecurity-obesity conundrum is one of the BIG IDEAS dietitians can lead in the future.