From the food pyramid to The Biggest Loser, these 10 factors have profoundly impacted the way we view and consume food.
Food fads and diet trends have come and gone over the past 30 years, but only a few have profoundly influenced how we eat and how health and wellness professionals serve our clients. With insights from nutrition experts, let’s take a walk down memory lane to look (in no particular order) at 10 changes that have affected our diets and influenced our clients’ behavior.
1. Launch of Dietary Guidelines for Americans
In 1980, the U.S. Department of Health and Human Services (HHS) and the Department of Agriculture (USDA) began publishing the Dietary Guidelines for Americans every 5 years (HHS 2005). As the cornerstone of federal nutrition policy and education, the guidelines aim to answer these basic questions:
- What should Americans eat?
- How should we prepare our food to keep it safe and wholesome?
- How should we be active to be healthy?
The guidelines establish the direction of government nutrition programs, including research, labeling, nutrition promotion and nutrition assistance. They also form the underpinnings of consumer-friendly food guidance systems—the Food Wheel: A Pattern for Daily Food Choices (1984), the Food Guide Pyramid (1992), MyPyramid (2005) and MyPlate (2011) (USDA 2011).
“The Dietary Guidelines do more than just provide Americans a framework for a healthy lifestyle,” says Connie Diekman, MEd, RD, LD, nutrition director at Washington University and past president of the Academy of Nutrition and Dietetics. “They show that the government recognizes that the health and wellness of the nation is a top priority.” Over the past 30 years, Diekman says, the Dietary Guidelines have helped Americans focus on how they eat and exercise, because the guidelines are taught in schools, used in public health campaigns and showcased in the media. “Although Americans may have difficulty following the guidelines, [placing] attention on food, nutrition and exercise is a major public health concern and the Dietary Guidelines have been an important reminder for Americans,” Diekman says.
Trans fat has been around for over 100 years (AHA 2010). In the late 1800s, the Nobel laureate French chemist Paul Sabatier developed the process of vegetable oil hydrogenation, and by 1911, Procter & Gamble had introduced Crisco®, which contained trans fat. In the 1990s, growing scientific evidence showed trans fat’s correlation with higher levels of low-density lipoprotein (LDL) cholesterol (the so-called “bad” cholesterol), and health advocates and consumers started to regard trans fat as a villain (AHA 2010).
According to the American Heart Association’s “A History of Trans Fat,” health advocacy groups successfully badgered fast-food restaurants into omitting partially hydrogenated oils from their deep fryers in 1993, and 4 years later a law passed requiring food manufacturers to add trans fat to food labels. In 2006, the AHA recommended consuming less than 1% of total calories from trans fat and New York City became the first U.S. city to pass regulations limiting trans fats in restaurants (AHA 2010). Manufacturers climbed on board, and today consumers can enjoy tub and stick margarines, baked goods, nut butters and other items that have no partially hydrogenated oils and, therefore, 0 grams of trans fat.
The efforts have made a difference—in February 2012, the U.S. Centers for Disease Control and Prevention reported that trans fat consumption had dropped by 58% between 2000 and 2009 (CDC 2012).
Health advocates and consumers have been sounding the alarm over the detrimental effects of sodium in the diet over the last few decades. Excess sodium is widespread in the U.S. food supply, and “88% of Americans are exceeding the current government recommendations for sodium” (Pollock Communications 2011). As a result, the 2010 Dietary Guidelines for Americans rank sodium reduction as one of the top dietary priorities. The Institute of Medicine and other health advocacy groups are urging manufacturers to lower the amount of sodium in the foods they produce (USDA 2010; IOM 2010).
“More attention from consumers, the media and health professionals has been given to the importance of lowering sodium in the diet as rates of hypertension have risen and other ill-health effects have been identified,” say Lyssie Lakatos, RD, and Tammy Lakatos Shames, RD, the Nutrition Twins and authors of The Secret to Skinny: How Salt Makes You Fat and the 4-Week Plan to Drop a Size and Get Healthier with Simple Low-Sodium Swaps (Health Communications 2009). “Fortunately, there has been a growth in the number of foods available that are lower in sodium, including soups, chips, pretzels, breads, cereals, beverages, cheese and condiments,” the sisters say. “Because there is so much to offer now in the way of lower-sodium products, consumers are taking notice and many of our clients are making beneficial changes.”
High-Fructose Corn Syrup
Like trans fat, high-fructose corn syrup has been attacked in the media and by health activist groups. Unlike with trans fat, research supporting the detrimental effects of high-fructose corn syrup (over other sweeteners) is not strong enough to garner the backing of all health professionals.
As the New York Times reported in “A Sweetener with a Bad Rap,” since 1980 obesity rates have been rising, and so has high-fructose corn syrup intake (Warner 2006). “There is insufficient data to support that high-fructose corn syrup causes obesity,” says D. Milton Stokes, RD, co-author of Flat Belly Diet! for Men (Rodale 2010) and a private-practice dietitian in Connecticut, “but this doesn’t mean that we should consume it, or any sugar source, in mass quantities. After all, calorie-rich, nutrient-poor sweeteners typically found in foods without health benefits—like soft drinks, candies and baked goods—may be adding unnecessary calories to the diet.”
Supermarkets are doing a lot more to guide shoppers on their purchases—especially when it comes to health. “Gone are the days of consumers only considering the weekly ads and coupons when deciding which grocery store to visit,” says retail nutrition expert Annette Maggi, MS, RD, LD. “Today, more than 6,000 retailers across the country offer a point-of-purchase nutrition program, and shoppers have come to rely on their grocer to guide them to ‘better for you’ choices.” Maggi says the point-of-purchase tools include Nutrition iQ® at SuperValu® stores, SimpleNutrition® at Safeway and the ranking systems used in a variety of stores; for example, the NuVal™ System, Guiding Stars® and the Aggregate Nutrient Density Index (ANDI) used by Whole Foods Market®.
Supermarkets are also hiring health professionals, such as pharmacists and registered dietitians, to guide shoppers and give disease prevention advice. Maggi says shoppers can now take advantage of nutrition education classes; store tours; and healthy recipes and tips—written by nutrition experts—in supermarket newsletters and fliers.
According to The Hundred Year Diet by Susan Yager (Rodale 2010), bariatric surgery is the most drastic weight loss solution and is considered overwhelmingly effective (Yager 2010). In recent years, going under the knife to promote weight loss has increased in popularity, with a reported 200,000 surgeries taking place in 2007—10 times the number that occurred in 1997 (Yager 2010).
Over the years, just as the number of surgeries has changed, so has the perception of bariatric surgery as a solution. Vicki Bovee, MS, RD, LD, co-owner of Simply Smart Food Inc., has been working with bariatric nutrition for almost a decade. She says that when she first started, people resorting to weight loss surgery were often “judged as being lazy or without willpower.” Insurance company claims reviewers used to routinely deny coverage for the surgery, but Bovee says this view has changed dramatically. “For one, both the healthcare community and the public recognize that bariatric surgery is most often performed for health reasons and the resolution of co-morbidities,” says Bovee. “[It] has become a treatment for chronic disease,” she adds. “Bariatric surgery helps initiate weight loss, but success is dependent on the lifestyle changes that will help keep the weight off and promote a better quality of life.”
Awareness and popularity of organic, “green” and sustainable foods have grown along with the public’s concern for the environment. Kate Geagan, MS, RD, author of Go Green, Get Lean (Rodale 2009), says the “green movement” has influenced our eating behaviors because it has led more consumers to seek local and seasonal food—and show more concern for where and how their food is grown. “Consumers are reading labels more than ever, farmers’ markets are sprouting up everywhere, the organic food category has continued to grow, and people are demanding more transparency in how their food is processed and prepared,” Geagan says.
Geagan has also noticed that consumers are recognizing the benefits of including meatless meals—from a health and an environmental perspective. “Tofu is not just for hippies, street trucks and reality stars,” says Geagan. “With the help of celebrity chefs, dietitians and the health media, the public has learned how to make vegetarian and vegan fare delicious and recognizes the health and environmental benefits.”
In 1994, the U.S. Food and Drug Administration (FDA) set aside a category for dietary supplements that were neither “conventional” food items nor prescription or over-the-counter drugs (FDA 2009). According to one review of the history of this process, the Dietary Supplement Health and Education Act of 1994 (DSHEA) was established to accomplish two things: “to ensure continued consumer access to a wide variety of dietary supplements, and to provide consumers with more information about the intended use of dietary supplements” (Dickinson 2011). Under DSHEA, dietary supplement or ingredient manufacturers are responsible for ensuring that their products are safe before they reach the market.
Since the 1994 act was instituted, more supplements have hit the shelves, and consumers have more options. “DSHEA has given consumers the freedom to find a supplement of their choosing—and for a better price than if a prescription was required,” says Kathy Moore, RD, LD, past chair at Dietitians in Integrative and Functional Medicine. She notes that consumers should educate themselves, consult their healthcare providers and purchase from reputable manufacturers, since DSHEA puts the burden of safety and testing on the manufacturer.
Potentially a result of DSHEA is the significant increase in the number of adults reporting dietary supplement use (Gahche et al. 2011). Over 40% of adults in the U.S. reported using supplements between 1988 and 1994, while 53% reported using them between 2003 and 2006. This improves nutrition nationwide because most dietary supplements’ nutrient levels equal or surpass the Institute of Medicine’s Recommended Dietary Reference Intakes (Gahche et al. 2011).
“Gluten-free didn’t used to be so sexy,” says Stokes, the Connecticut dietitian. “Historically, it was a dietary modification prescribed for individuals diagnosed with celiac disease.” About 1% of the U.S. population is affected by celiac disease, and only 5% of those people know they have it (Marcason 2011). A gluten-free diet excludes gluten-containing grains like wheat, barley, rye and triticale (a cross between wheat and rye) (Mayo Clinic 2011).
Although regarded as a therapeutic diet for a gastrointestinal disease, gluten-free eating is now being promoted by celebrities, athletes and bloggers. Time magazine reported that Americans spent $2.6 billion on gluten-free products in 2010 (Steinmetz 2011). Interestingly, about 8%–12% of gluten-free consumers were diagnosed with gluten intolerance, 46% went gluten-free because they thought it was healthier, and 30% purchased gluten-free foods for weight management (Steinmetz 2011).
Contrary to popular belief, research has not shown that gluten-free eating helps people lose weight, but it may result in a diet that is low in carbohydrates, iron, folate, niacin, zinc and fiber (Marcason 2011).
“Bottom line,” says Stokes, “gluten-free alone does not mean lower-calorie or more nutritious.”
The Academy of Nutrition and Dietetics defines “functional foods” as whole foods and fortified, enriched or enhanced foods that have potential health benefits when consumed regularly as part of a varied diet (ADA 2009). In 1998, establishment of the National Center for Complementary and Alternative Medicine within the National Institutes of Health showed a commitment to investigating functional foods (ADA 2009).
Kathy Moore says her emphasis on functional foods with consumers has grown as the scientific evidence has strengthened. “Rather than only focusing on calories and macronutrients, I encourage people to look for foods that have additional health benefits that can help prevent chronic disease.” Moore provides examples like whole foods, such as richly colored fruits and vegetables (tomatoes, dark leafy greens, cranberries, raspberries, blueberries), calcium-fortified orange juice, and tub margarines with plant sterols that lower cholesterol. She adds, “[I have] no doubt that research into bioactive health components of food will continue and more health benefits will be discovered.”
Consumers are paying attention to functional foods. For the past two decades, the International Food Information Council (IFIC) has been collecting data on consumer attitudes toward these foods (IFIC 2000, IFIC 2011). According to IFIC, since 1998 there has been a significant increase in consumer awareness of foods and beverages that may provide benefits beyond basic nutrition, and consumers continue to be interested in learning more about these options (IFIC 2011).
In 2004, becoming the “biggest loser” became an accolade, not an insult. The reality television show The Biggest Loser debuted on October 19, 2004, with a group of obese contestants vying for a cash jackpot and the honor of becoming the most successful loser . . . of weight, that is. With the help of personal trainers and diet instruction, players on the show expose their struggle to lose weight with sweat, tears, unflattering T-shirts and Spandex to TV viewers across the country. The New York Times reported that in 2009, over 200,000 people submitted audition tapes, and by its eighth season, the NBC show was attracting an estimated 10 million viewers each week (Wyatt 2009).
As expected, this extreme-body-makeover program drew criticism and compliments from the medical community, and it has affected how we view weight loss—particularly in a group setting. Naysayers balk at the competitors’ access to personal trainers and around-the-clock support, while medical professionals worry about the health risks of rapid weight loss (Wyatt 2009).
Nevertheless, many health experts agree that promoting weight loss and getting people excited about diet and exercise are steps in the right direction. “Encouraging people to take control of their eating and introduce exercise into their daily lives is a positive message,” Stokes says. In addition, he supports the trend of office-based and group weight loss programs. “Many calories are consumed in the workplace with grazing, birthday parties and sharing leftover treats,” says Stokes. “If [office workers start] to mind their waist together, it may help reduce the number of snacks and bowls of nutrient-poor candies on desktops and in common areas.”
Research supports Stokes’s assertion. In 2012, researchers from The Miriam Hospital’s Weight Control and Diabetes Research Center and the Warren Alpert Medical School of Brown University, both in Providence, Rhode Island, published data in the scientific journal Obesity showing that a team-based weight loss competition significantly influenced team members’ outcomes (Leahey et al. 2012). Team members lost similar amounts of weight, and those who credited teammates for having a large role in their success lost the most weight.
In 1990, the U.S. Census Bureau pegged the total United States population at 248.7 million, with 80% of Americans self-identifying as “white,” 12% as “black” and 8.9% as “Hispanic.” Fast-forward to 2010 and the make-up has shifted. Now, 72% identify themselves as “white,” 12.6% as “black” and 16% as “Hispanic” (excluding Puerto Rico’s 3.7 million residents). The trend is expected to continue in future decades. The Hispanic population grew by 43% between 2000 and 2010, compared with a nationwide growth rate of 9.7% (U.S. Census Briefs 2010). By 2050, the U.S. Census estimates that 30% of the population will be Latino (U.S. Census 2012).
The U.S. now has a “cultural plurality,” says Hope Barkoukis, PhD, RD, LD, associate professor in the department of nutrition at Case Western Reserve University’s School of Medicine. Barkoukis puts a priority on diversity in her teachings, emphasizing the ways it affects how Americans eat and how wellness professionals practice. “It’s important for the clinician to understand that one’s ethnic group influences not only the food choices [people] make, but how they see the world. In other words, some cultures strongly believe in fate, so personal responsibility related to health and food choices is an unfamiliar concept.”
Barkoukis has found that when people move to the U.S., their food habits and health behaviors are among the last things they change. Health professionals should therefore help clients find ways to incorporate their traditions into recommendations for healthy behavioral changes. Barkoukis adds that the increase in cultural diversity offers an exciting opportunity to create food and fitness programs that suit this new America.