While I admit I have a bias, I do wonder about the 70,000 registered dietitians who focuses on helping people - healthy, sick, young, old - make food choices that meet their needs. And what about the Academy of Nutrition and Dietetics spokespersons who interact with the media everyday, providing context and guidance on the day's issue or controversy. What about leading nutrition scientists in government and universities. Are their messages not as dramatic?
We're all aware that confusion over food and health abounds. Not only is nutrition a very complex area of study, effective nutrition-related advice must take individual preferences and behavior into account. While I have no objections to Pollan's choices, I think he stopped short of the mark. Number eight on his list should be the registered dietitian.
]]>We are not going to solve this country's obesity problem unless we reach out to all age levels. So let's not spend any more research dollars trying to establish who is most at risk. We're all at risk. Our focus should now shift to action - what works. What can people do to achieve and maintain a healthy weight at any age? What are the common denominators for people of all ages? What are the key messages? That's where our focus should be.
We already have an abundance of studies suggesting "appropriate" messaging. For example, skip one meal; eat smaller meals more frequently. Limit certain foods; eat more fruits and vegetables. How do we use all this information? My opinion is that we need to take a page out of the books of leaders like Ronald Reagan and Bill Clinton. These two great communicators advised that leaders who get things done focus on just a few key issues or messages.
As nutrition advisors, so should we. The Institute of Medicine (IOM) offers us some help here. In its recently released report, Leveraging Food Technology for Obesity Prevention and Reduction Efforts, the IOM authors make three points concerning strategies that work: Focus on portion size, frequency of snacking (especially among teens) and meals eaten outside the home. The IOM report provides the evidence to support these three strategies. Take a look. As the German writer/poet, biologist and physicist Johann Wolfgang von Goethe famously said, "Knowing is not enough; we must apply. Willing is not enough; we must do."
It's almost 2012! How can this be? Didn't we identify and address this problem in the early 1980s? With so many advances in disease-specific nutrition therapies, how can we be facing this problem again?
And this time around, it's not only about doing the right thing for patients; it's about money. When provisions of the Affordable Health Care Act take effect in July 2012, hospitals will be penalized for unnecessary readmissions that occur within 30 days of discharge for certain conditions. Patients who are discharged in a malnourished state or without access to the nutrition therapy necessary to support continued recovery are extremely vulnerable to unnecessary readmission.
I spent the majority of my career as a dietitian/nutritionist with Abbott Nutrition (formerly Ross Laboratories) - for more than two decades, the leading the manufacturer of medical nutrition products. In 1989, Abbott created and funded the Nutrition Screening Initiative, a multifaceted campaign to educate hospital professionals about the need to identify patients at nutritional risk and intervene before complications develop. We promoted the seminal work of scientists like George Blackburn, PhD, MD, and B. R. Bistrian, PhD, MD, that demonstrated the seriousness of iatrogenic malnutrition - that is, protein-calorie malnutrition brought on by treatments, medications and hospitalization.
Abbott was committed to providing solutions to prevent and treat patients at high risk for this condition. As we had done many times in the past, we once again showcased the value of the registered dietitian, this time as an architect of effective prevention and treatment of iatrogenic malnutrition.
That was then. Here's where I think we are today: Nutrition's role in health and wellness garners a lot of attention, with much of the focus centering on obesity. With overweight so prevalent in this country, I fear that we just assume that it's okay for a person to not eat for a few days. Not true - especially among the sick and the elderly. What we need to remember is that malnutrition and obesity are not mutually exclusive.
To advance nutrition science and promote best practices, we must build on what we have learned, not abandon it. Hospitals are under tremendous pressure to develop protocols that help avoid costs. Here's an easy (and familiar) one: Assess nutrition status at admission. Provide necessary nutrition support during hospitalization. Prescribe continuing nutrition therapy at discharge. It's not a new idea. But it is an idea whose time has come.
]]>Epstein's study gives us reason to ponder this automatic response. The authors found that women, whether in the study's obese or its non-obese group, ate more food when they were given a variety of foods every day. Subjects in both groups who were fed the same macaroni and cheese every day for weeks, however, decreased their intake and consumed fewer calories. This finding brought back memories of the all-banana or all-hot dog or all-ice cream diets that surface from year to year with a promise to cure obesity. Of course, it's not the particular food that's making a difference - but does the lack of variety play a role?
Here is what this study and the accompanying commentary say to me and what I believe nutrition professionals should be thinking about as they try to help consumers adopt healthy eating patterns and/or lose weight:
· Keep an open mind to all (basically sound) approaches. What works for one person may not work for another. Find out what the consumer wants and build around that foundation. Innovate!
· Food-related behavior is very complex. It's going to take a long time to unravel the brain chemistry involved. Understanding behavior modification strategies is becoming increasingly important. Get familiar with this research and share your views.
· Take a leadership position in the profession by developing your expertise in behavior and food intake. Determine how your work on the front lines with consumers can move the field forward.
]]>When tackling the obesity issue in this country we focus on children and adults. Adolescents are often overlooked, but according to the Centers for Disease Control, the prevalence of obesity among those aged 12 to 19 years has increased from 5.0% to 18.1% over the past 30 years. Type 2 diabetes among teens has increased dramatically as a result.
How about intervening at the start of junior high and again before college with a screening that includes an assessment of healthy weight. When there is an issue with overweight or obesity (or disordered eating), these teens can be referred to private or community resources for help learning to maintain weight successfully and pursue a healthier lifestyle. This strategy takes advantage of natural transitions in a teen's life and, once established, will become a normal part of progressing through school.
Obesity, which affects one-third of all children, and conditions related to obesity cost families and our country dearly. According to the Children's Defense Fund:
• Annual medical costs for a child diagnosed with obesity are on average three times higher than those for a child who is not overweight or obese.
• Nationwide, it is estimated that annual costs for prescription drugs, emergency room treatment and outpatient services related to childhood obesity total more than $14 billion, with an additional $238 million in inpatient hospital costs.
• If the childhood obesity trend continues, experts predict it could cut two to five years off the lifespan of the average child in America - making this the first generation to have a shorter life expectancy than its parents.
Sound health practices that help prevent disease must begin in early childhood, but even among children, it's very hard to change unhealthy behavior. The good news is that obesity can be prevented and that disease prevention is poised to assume greater urgency with the June release of The Public Health Institute's National Prevention and Health Promotion Strategy. This blueprint for realigning the nation's healthcare system details the role that all sectors must play in containing costs and reducing disease. Surgeon General Regina Benjamin described this strategy as the "Americas Plan for Health and Wellness."
Many communities already have good health promotion programs in place, but now we must unite behind a master plan by connecting and collaborating. Granted, it can be challenging to change our mindset from disease treatment to disease prevention, but it's the only way we can reverse trends that are undermining our country's well being - including our health, economy and even national security.
Start by reading the National Prevention and Health Promotion Strategy. Use a wide net to identify and connect with all the health-related programs in your community. Focus on areas where you can have an impact. And be sure to put healthy eating and physical activity at the top of your list.
]]>Earlier this year, television's 60 Minutes alerted the nation about hunger in our nation's families. This news was shocking to many Americans. We have been relentlessly focused on helping our children make healthy choices and eat fewer calories. School lunch and breakfast programs have lowered sugar and fat content and reduced portion sizes. And now we're told many of our children are not getting enough to eat? How can these two problems - obesity and hunger - exist side-by-side in the same community, in the same school, in the same family and, most confusing of all, in the same person?
The fact is that more than 12 million children under age 18 are not assured of the availability of nutritious food. Under-employment, unemployment and even poverty have crept into families where they never existed before. People who needed no assistance now frequent food banks and other catch-as-catch-can resources. These people are the definition of "food insecure."
We all know that hungry children get sick more often and hunger can compromise long-term health, growth and development. When compared to children who are not worried about if and when they will eat, poorly nourished children have lower academic achievement, are unable to concentrate, and display social and behavioral problems.
Low income is one factor behind this situation, but food insecurity - that is lack of access not only to food but also to healthy food - isn't exclusive to communities where incomes are traditionally below the poverty level. A child need not appear malnourished to be food insecure - and that is the key to how obesity and hunger can exist side by side.
The obesity-hunger dichotomy reminds us of the impact of lack of resources, lack of access to healthy food, cycles of food deprivation and overeating, and stressful lives. Because our children's ability to learn is critical to the future of every sector of society, we must be strong advocates for the expansion of child nutrition programs. A meal at school may be the only meal and/or the only healthy meal that many of today's children receive.
We also must be aware of all the resources already available to combat food insecurity in our communities. Kudos, for example, to the state of Virginia - and actor Jeff Bridges and Gov. Bob McDonnell - for the No Kid Hungry Campaign, which seeks to raise awareness of the availability of state and federal food programs. This kind of advocacy is exactly what we need to ensure hungry people take full advantage of every opportunity available for nutritious food.
]]>This perspective was reinforced last week in a discussion with one of my former professors, an esteemed biochemist now retired from The Ohio State University (where I earned my doctoral degree). He gave me a refresher course on the metabolism of sugar.
HFCS is manufactured form corn syrup, which undergoes an enzymatic process to increase its fructose component, making it about half glucose and half fructose - just like sucrose (table sugar). Thus, the label "high fructose" is somewhat confusing: HFCS has more fructose than regular corn syrup but also has an equal amount of glucose. Some critics claim that this process alters metabolism, thus causing diabetes, obesity and metabolic syndrome; however, there is little evidence to support this theory.
And now, the controversy over HFCS has brought another issue into play - the role of fructose, the sugar found in fruit. Enough already!
The really important issue here is consumer confidence - confidence in what we as nutrition professionals recommend. The news isn't good. For example, the International Food and Information Council's latest survey reveals a disturbing trend: Consumers are less concerned about their weight and do not count calories.
I am concerned that by delving so deeply into food ingredient/ processing and by making pronouncements based on so little real proof, we are creating unnecessary fear in the minds of consumers and undercutting our voice of authority in food and nutrition. I am concerned that debates like the HFCS skirmish push consumers to disregard our recommendations. Think about it: Lately, even newscasters and talk shows roll their eyes over the "next round" of nutrition advice."
Yes, it is important to have a conversation - and a debate when necessary - about the ingredients in our food, but let's not create so much fear that we destroy Americans' confidence in their food supply. Behind all the noise is a simple fact: Products containing HFCS can be part of a well-balanced diet of smaller portions and fewer calories. That's what we should be teaching.
]]>But back to the topic at hand: When it comes down to it, aren't all foods functional? How about the vitamin C in orange juice versus the vitamin C added to oj? Does enrichment with a vitamin already present in a food suddenly make that food functional? It's becoming too complex to place food in such categories. Maybe it's time to stop.
Yes, food companies do promote the various health benefits of their products. Within responsible parameters, so what? They invest in scientific research to develop these products. If we want to see greater investment in nutrient science, we need to evaluate and work with the data we're given - or there won't be any investment.
Where nutrition professionals enter the picture - and I am referring to professionals in all branches of dietetics - is in helping people understand their choices and decide what foods meet their needs. For example, is calcium low in the diet? If so, choose a food with added calcium. On a special renal diet? Avoid foods with potassium. It comes down to making the best selection for the individual. As advances in science reveal more about added nutrients, interrelationships between nutrients and personalized nutrition plans, it's our job to help consumers understand what is optimal for them.
So let's stop worrying about the food industry and what it's doing to market functional foods. Let's focus on helping consumers understand the value of reading the label and picking the foods that are right for them.
]]>Soon after Congress passed this legislation, FDA Commissioner Margaret A. Hamburg, MD, issued a statement that bears repeating here:
Passage of the Food Safety Modernization Act has laid the critical foundation for a prevention-based 21st century food safety system. This law makes everyone responsible and accountable at each step in today's global food supply chain. Under this new law, FDA will now have new prevention-focused tools, as well as a clear regulatory framework, to help make substantial improvements in our approach to food safety. Preventing foodborne illness is a core public health principle that is especially critical in an increasingly complex and globalized world. This law helps us take the critical steps toward strengthening the food safety system that is vital to the health and security of the American people.
Some of you might wonder the status of FDA's FSMA-realted activity and what is being done to implement the law. In a letter to stakeholders issued earlier this month, Michael Taylor, FDA deputy commissioner for foods, detailed agency actions and invited those interested to sign up to receive regular status reports. (Sign up here.)
Clearly, this effort is a major undertaking for FDA due to the agency's limited staff and the complexity of the food safety issue. The agency is, however, making progress on steps such as devising ways to inform consumers of recalls, especially in areas of greatest concern such as seafood and imports.
I think it's safe to say that all of us in the food and nutrition profession support greater consumer protection and applaud FDA actions. But let's not leave this challenge in FDA's lap. Remember there are things we can do right now to educate consumers about their responsibility in prevention food borne illnesses.
Is it possible to create a risk-free food supply? No. Outbreaks will continue to occur despite FDA's work and FSMA implementation. As dietitians, we have an important role to play in educating consumers on how to prevent foodborne illness in the home and in teaching workers restaurant, school, medical facility and cafeterias kitchens how to handle food safely.
Alarming statistics reported by the Partnership for Food Safety should convince everyone to be careful when handling food: Seventy-six million cases of foodborne illness occur annually in this country; 325,000 people are hospitalized; and 5,000 people die. But guess what: These numbers are not for lack of FDA effort. Most cases of foodborne illness can be prevented. Teach consumers to use a food thermometer to tell if cooked food has reached a proper temperature. Only 15% of Americans do this. More than half of consumers sometimes defrost meat and poultry at room temperature, thus permitting bacterial growth. And only a third of consumers use separate cutting boards for raw and cooked foods, not to mention washing their hands after handling raw food. And the list goes on.
With support from Conagra Foods, the American Dietetic Association (ADA) offers an education program to assist in outreach efforts and remind consumers and food preparers about safe food-handling practices. To download information on education strategies, check
And remember, while FDA does what it can do to assure a safe food supply, food and nutrition professionals need to do their part as well. FDA Commissioner Dr. Margaret Hamburg is right on target when she says that everyone is responsible and accountable at each step in today's global food supply chain.
In a special edition on risk communication, FoodNavigator.com briefly examined how communication is challenged when highly inconclusive and contradictory data surround a single ingredient or food. Recently, we have seen this phenomenon with sodium, and controversies remain ongoing over saturated fat, high-fructose corn syrup and calcium - just to name a few.
Unfortunately, though it is at the core of dietetics practice, we have not yet discovered the solution to this communication dilemma. Most consumers do not respond to contradictions and competing theories with, "No problem. That's just the evolutionary nature of scientific discovery." Rather, they want answers - now.
I think one of the biggest challenges that dietetics will face in the future is establishing and maintaining authority amidst the ever-increasing cacophony of scientific findings in nutrition - a cacophony fed by the continuous loop of more research, more media and more interest in health.
Instinct tells me the answer to this communications challenge rests in three principles: scientific context, individuality and professional judgment. It is up to us as nutrition professionals to be the voice of authority - to help not only consumers but also other health professionals, media, and the food industry develop a mindset that demands scientific findings be viewed in context and disallows over-generalizations that undermine productive, individual decision-making.
Stay tuned for more on this subject. In the meantime, if you have any thoughts you would like to share, please comment.
]]>As the world becomes a smaller place, food insecurity in our own backyard (including middle-class backyards) and on the other side of the world is no longer somebody else's problem. It's is a global threat. Hunger destabilizes governments, weakens societies and undermines human capacity for learning and progress.
I believe that we, as nutrition professionals, must broaden our "systems thinking" to include the very real problem of food insecurity - from lack of food to lack of healthy food options, and everything in between.
In early May, the Ford Foundation, Bill & Melinda Gates Foundation, William & Flora Hewlett Foundation, David and Lucile Packard Foundation, W.K. Kellogg Foundation, McKnight Foundation, Rockefeller Foundation and Walton Family Foundation launched AGree, an initiative designed to address the long-term food and agriculture policies confronting this country and the world.
Solutions to the problems we face in this arena require best-in-class research, comprehensive analysis and dialogue across multiple sectors, including health and nutrition. One of AGree's leaders, Dan Glickman - former Secretary of the U.S. Department of Agriculture under President Bill Clinton and a former 18-year Kansas congressman promises that AGree "will elevate the agriculture and food policy conversation . . . [and] will make it clear to leaders and policymakers that, while difficult, solving food and agriculture issues is of utmost importance and can help solve other pressing problems including public health and the need for economic growth."
I think this initiative is one to watch - both for what it can accomplish toward refining and accomplishing its mission and for the strategic collaboration model it creates. Why can't we take three of the world's most threatening, co-dependent problems - hunger, public health and economic stability - and integrate them into a solution? I think we can, and I believe nutrition is the common denominator.
]]>No one can argue with the fact that we have a responsibility to fight this nation's obesity crisis by helping children select healthy foods. In fact, all sectors of society - parents, schools, communities, health care professionals, media and industry - play a role in teaching children how to eat all foods, including those that may be considered special treats. Research and our experience to date demonstrate that this issue is very complex; there is no easy fix.
What concerns me about this latest volley in the battle against obesity is the apparent supposition that food companies are inherently irresponsible and require government policing. An uninformed person reading the interagency group's report would walk away with the impression that the food industry has done nothing to ensure responsible marketing to children, when in truth, food manufacturers have already curtailed advertising of their least healthful products to kids. (See recent Grocery Manufacturers Association survey here.) In addition, in recent years, food companies have changed the recipes of more than 20,000 products to reduce calories, fat, sodium and sugar.
And if this is not enough, keep in mind the food industry's support of initiatives such as the First Lady's Let's Move campaign as well as the Healthy Weight Commitment Foundation and its predecessor the American Council on Fitness and Nutrition.
As nutritionist and dietitian who has spent her career in the private sector, I can assure you that food companies are not interested in marketing products to a burgeoning health-conscious segment of the population that doesn't want those products, nor are they interested in harming children!
Finally, the interagency group's published document concludes with 30 questions that commenters are encouraged to use as guidelines for discussion. One of these questions really got my attention: ". . . If Congress were to enact them [these principles] into law, would such a law raise First Amendment concerns? If so, what are those concerns?"
You have been warned!
]]>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.
The Authenticity Hoax: How We Get Lost Finding Ourselves by Andrew Potter. Harper, 2010
The Wisdom of Crowds by James Surowiecki. Anchor, 2005
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