Making sense of federal dietary guidelines and other health improvement initiatives.
From the White House to local school boards, our government has ambitious goals for improving how we eat and challenging policies that encourage unhealthy diets. Objectives of current health initiatives include the following:
- Broaden the scope of Dietary Guidelines for Americans (DGA) to confront policies that conflict with nutritional goals (see the sidebar “Can Federal Dietary Initiatives Reform the U.S. Food System?”).
- Fight childhood obesity via Michelle Obama’s Let’s Move! program.
- Clarify food-labeling regulations.
- Improve standards for food and drinks sold in schools.
- Tax sugared beverages to discourage consumption.
These goals raise a lot of questions for fitness professionals and their clients. Let’s take a closer look at the answers.
A good starting point for understanding all these issues is Dietary Guidelines for Americans, 2010, released in January 2011. DGA are established by the U.S. Department of Agriculture (USDA) and Department of Health and Human Services (HHS) and are updated every 5 years. The guidelines provide opportunities to clear up confusion in a fitness client’s mind.
Two overarching directives stand out in the latest DGA:
- Maintain calorie balance over time to achieve and sustain a healthy weight.
- Focus on consuming nutrient-dense foods and beverages.
Easier said than done. While most consumers want to improve their diet, a majority are unaware of their calorie needs: 58% do not try to balance calories in against calories out. Close to half of Americans find food and health information confusing and conflicting (IFIC 2010)—giving us a chance to step up our strategies for education and behavioral change.
The key 2010 DGA recommendations are straightforward:
- Enjoy your food, but eat less.
- Avoid oversize portions.
Ever have clients frustrated by all the time they commit to their fitness plans, only to see the numbers on the scale refuse to budge? Such difficulties in achieving energy balance present an educational opportunity. “Fitness professionals can open a dialogue about the important role of balancing their calories with their energy expenditure,” says Heather Mangieri, MS, RD, CSSD, sports dietitian in Pittsburgh and spokeswoman for the American Dietetic Association. Self-monitoring food intake is a useful way to help clients understand their food consumption, as is estimating portions using familiar objects (11/2 ounces of cheese = 9-volt battery) or the hand (size of fist = 1 cup). Consider simple calorie trade-off tips, such as eating a smaller dinner if lunch was big or sharing a meal when eating out.
“Fitness professionals can help nutrition experts explain simple concepts such as what a portion size looks like, energy balance and the importance of fruits and vegetables. Most important, however, is to be mindful and listen to our body,” Mangieri says. “When we become full, we have to stop eating.” She urges clients to chew gum while preparing food, then savor the meal by eating slowly and taking breaks. That gives the brain more time to process satiety—the sensation that you have had enough to eat.
- Make half your plate fruits and vegetables.
- Switch to fat-free or 1% milk.
The key here is choosing whole, minimally processed foods over highly processed, packaged products. The scientific evidence supports shifting to a more plant-based diet by choosing more fiber-rich carbohydrates such as vegetables, beans, fruits, whole grains, nuts and seeds (DGAC 2010). Adding fat-free and 1% milk products addresses nutrients of concern in American diets: potassium, calcium, vitamin D and fiber.
The recommended daily amounts for adults are 2–3 cups of vegetables and 1.5–2 cups of fruit, emphasizing dark-green, red and orange vegetables, and beans. You can teach clients to build from that message by filling half the plate with fruits and vegetables, and filling a quarter of their plate with a lean protein and a quarter with whole grains. This teaches balance and portion control.
DGA daily protein suggestions remain unchanged, but they focus on the importance of quantity, quality and leaner choices—with seafood replacing some meat and poultry during the week. Increasing the amount and variety of seafood consumed to two 4-ounce servings per week, especially of cold-water fish, will provide a major source of essential omega-3 fatty acids and promote heart health.
- Compare sodium levels in foods like soup, bread and frozen meals—and choose products with less sodium.
- Drink water instead of sugary drinks.
Though reducing sodium is a priority at many food companies, the majority of Americans still consume far too much salt. The current average sodium intake is 3,400 milligrams (mg) per day (DGAC 2010), more than double the 2010 DGA goal of 1,500 mg a day. This limit applies to half the U.S. population, including children and the majority of adults (those over age 50, African Americans, and those who have hypertension, diabetes or chronic kidney disease). The DGA upper limit of 2,300 mg (1 teaspoon of salt) applies only to adults outside the high-risk groups.
“Sodium appears throughout the food supply, even in recommended foods like low-fat dairy and whole grains,” says Joanne Slavin, PhD, RD, professor in the department of food science and nutrition at the University of Minnesota and a member of the 2010 Dietary Guidelines Advisory Committee. “Consuming less than 1,500 mg of sodium daily, especially when calorie needs are high, is essentially impossible.” These sodium guidelines are not useful for endurance athletes (in fact, following them could affect performance and/or health).
Clients asking about sodium should be advised to scan food labels and ingredient lists for hidden sodium. By encouraging clients to cook more at home and to eat out less often, you will naturally guide them toward more fresh, whole, naturally salt-free foods.
The quality of carbohydrates and fat in the diet is as important as the quality of protein. Replacing saturated and trans fat (solid fats) with mono- and poly-unsaturated fats is more effective in lowering cardiovascular disease risk than reducing total fat (DGAC 2010). In other words, clients should limit full-fat dairy, butter, fatty meats and stick margarine and go for vegetable oils and tub margarine, nuts, avocados and olives. Foods containing solid fats and added sugars contribute nearly 800 calories a day to the American diet and offer little or no nutrients (DGAC 2010). Top contributors include grain-based desserts (cakes, cookies, etc.), sodas and other sugar-sweetened drinks, regular cheese, sausage/franks/bacon, pizza, fried potatoes, ice cream and candy. Because these foods are more likely to lead to weight gain and lower vitamin and mineral intake, for most people it’s recommended that solid fats and added sugars not exceed 5%–15% of total calories (DGAC 2010).
An updated graphic, called MyPlate, was unveiled in June to help people adopt the new guidelines. “Fitness professionals can be very valuable in introducing their clients to the Dietary Guidelines for Americans,” Mangieri says. Just be sure to stay within the scope of your practice and refer clients to a registered dietitian when they ask specific questions about implementation or the science of nutrition.
While the fundamentals of the updated DGA didn’t change much, there is a greater sense of promise in national efforts such as First Lady Michelle Obama’s Let’s Move! campaign.
Digging dirt with kids in the White House garden was just the beginning of a national quest to cure childhood obesity within a generation. Let’s Move! is built on the premise that everyone has a role to play, and the White House Task Force on Childhood Obesity has developed a national action plan with 70 recommendations that cut across multiple sectors. The Let’s Move! Initiative has five main pillars:
- Create a healthy start for children.
- Empower parents and caregivers.
- Provide healthy food in schools.
- Improve access to healthy, affordable foods.
- Increase physical activity.
In addition to influencing federal nutrition policy, Let’s Move! aims to engage and mobilize families, schools and communities. In its first year, the campaign started the Chefs Move! to Schools program, invited mayors and local officials to make a commitment to increase opportunities for physical activity and healthy eating in their communities, partnered with healthcare providers to exhort kids and families to eat more fruits and vegetables and be physically active for 60 minutes a day, and used the HealthierUS School Challenge to give schools an incentive to raise nutrition standards. Now children and adults are encouraged to take the Million PALA [Presidential Active Lifsetyle Award] Challenge and commit to being active.
IDEA member Karen Jashinsky, MBA, CPT, founder of O2Max Fitness in Santa Monica, California, illustrates how the fitness industry can contribute to Let’s Move! Recognizing a need for youth-focused fitness programs, Jashinsky listened to the problems, challenges and concerns of parents and teachers, then offered suggestions and helped implement them. “You have to be willing to offer help sometimes and not sell, but participate and be a resource,” says Jashinsky, who helped high-school students revamp their school café menu. Fostering this relationship and partnering with businesses to offer perks, the O2Max Fitness “Primp for Prom” program guides teen girls toward healthy fitness and eating habits and has creatively become a school fundraiser.
“We can’t do big things alone. We have to create alliances and partnerships to reach the community,” Jashinsky says. “For example, Tour de Fitness started off as a guerilla marketing campaign to raise awareness for O2MAX and with partnerships has become a family-friendly event that engages hundreds in a 6-mile interactive walk through Santa Monica.” (For tips on getting involved in your community, see the sidebars “Be a Community Champion” and “Get Involved.”
Let’s Move! garnered attention and support for the passage of the Healthy, Hunger-Free Kids Act (S. 3307). In addition to reauthorizing the federal child-nutrition programs, the act finally gave the USDA authority to set national nutrition standards for all foods and beverages sold competitively on campus (e.g., in vending machines). Many states and districts have set their own standards, leading to inconsistent implementation. Signed into law in December 2010, the legislation takes a hard look at the food kids eat in school and seeks to improve the nutritional standards for school meals for the first time in 15 years.
Together, federal school breakfast and lunch programs feed more than 30 million kids a day. As more children rely on school meals, nutrition quality is even more important. With an estimated $1 to spend on the food in each student’s lunch, achieving good quality is no small undertaking. The reauthorization of the USDA program increases the reimbursement rate and gives schools an additional 6 cents per lunch to help purchase healthier foods.
But don’t expect a school meal overhaul with this amount. “In many communities, 6 cents is the cost difference between a serving of whole-grain bread and a serving of white bread, or the difference between portions of fresh versus canned fruit,” says Nancy Rice, MEd, RD, LD, SNS, president of the School Nutrition Association. “So 6 cents more a lunch can help improve school meals, but it won’t cover the cost of meeting the proposed changes to federal nutrition standards for school meals.” And there is no increase in breakfast reimbursement.
These proposed changes, which align with the DGA, are based on recommendations from the Institute of Medicine (IOM) report “School Meals: Building Blocks for Healthy Children” (IOM 2010). The proposals would reduce staples like pizza and fries and add more fruits, vegetables, whole grains, and fat-free and low-fat dairy to the tray. Limits on calories, sodium, saturated and trans fat would also be set.
"The USDA estimates that meeting these new standards could eventually increase the cost of preparing school meals by more than 15 cents per lunch and 51 cents per breakfast,” says Rice, explaining that these figures include costs for food, storage and new equipment for prep and training. “To help schools meet the new meal standards, Congress must protect funds for school meals, and the USDA must support schools as they seek ways to cover these costs."
Every school district faces different challenges in their effort to serve healthier meals, now required by the 2013 school year. Many districts have already taken steps toward the new requirements, and success stories from across the country, including farm-to-school programs, can be found at www.traytalk.org. “Fitness professionals and parents should also visit their school cafeteria for a meal and talk with the cafeteria manager to find out what’s going on in their local school," Rice says. She emphasizes that everyone has a role to play in encouraging children to choose the healthy options available at school, adding, “Nutrition education initiatives will be critical to teach children why they should [eat] these healthier meals."
Food labeling is a hot topic these days, evidenced by the voluntary front-of-pack nutrition marks on many food packages. Amid complaints that multiple symbols and nutrition standards are confusing consumers, the U.S. Food & Drug Administration is contemplating how point- of-purchase labeling can best be used to provide easy access to nutrition information. An FDA-regulated, standardized front-of-pack symbol displaying calorie, trans fat and sodium information may be in the works to strengthen consumer understanding, according to an IOM committee report released in fall 2010. It’s been noted that it will be a long time before any changes reach our food packages.
In the meantime, more Americans will see calorie information posted on their favorite restaurant menus. First passed in New York City in 2008, menu-labeling laws have spread to cities across the nation, and a menu-labeling provision tucked into the Patient Protection and Affordable Health Care Act of 2010 will trump local laws. The new rules require chain restaurants with at least 20 outlets nationwide to provide point-of-purchase calorie information to customers; the rules will also apply to vending machines. (Final rules are expected by the end of this year; they will include an implementation/compliance date.)
Yet one big question remains: Do consumers use this information to make healthier choices? Research in New York City found that posting calorie information increases consumer awareness (Dumanovsky et al. 2010), but findings vary on whether it influences food choices. For example, a study from King County, Washington, showed no impact on purchasing behavior after the law was enacted (Finkelstein et al. 2011). Yet in another study, researchers concluded that calorie information helped consumers eat less, and that when labeling included how many daily calories an average person needs, consumers ate an average of 250 fewer calories (Roberto et al. 2010). In the long run, menu labeling may also sway restaurants to offer more lower-calorie options.
Many health advocates see raising prices as a way of reducing consumption of sugar-sweetened beverages. Several state and local governments have passed or are considering legislation to tax such soft drinks in order to lower consumption and fund preventive health programs. A bit trickier when applied to food and beverages, this policy approach worked for reducing tobacco use and funding prevention programs. Since sugary drinks are a top energy source and specifically mentioned as beverages to ditch in the 2010 DGA, there will no doubt be more efforts toward a penny-per-ounce tax. While there is limited research on how taxing sugar-sweetened drinks would affect the obesity epidemic, we know that raising prices does reduce consumption. Studies have estimated that a 10% increase in the price could reduce consumption by a similar percentage (Duffey et al. 2010).
Even though fitness is your focus, you can still discuss the DGA and government nutrition policy changes with your clients. Furthermore, as a fitness professional you are in a prime position to put your knowledge, passion and expertise to work supporting regulations and community efforts that help make healthy eating and physical activity the easy choices for all Americans.