Despite recent success in developing broad dietary guidance and improving nutrition labeling policies, Americans still face considerable dietary challenges, according to recent research.
"Five out of the 10 leading causes of death for Americans relate to dietary practices: heart disease, some cancers, stroke, diabetes, and atherosclerosis," said Karen Glanz, PhD, MPH, of the University of Hawaii's Cancer Research Center in Honolulu.
Glanz conducted an extensive review of dietary behavior change programs throughout the U.S. Her research indicates that programs that encourage dietary behavior change are most effective with individuals who are motivated by having or being at high risk for diet-related diseases. Glanz reports her findings in the November/December issue of the American Journal of Health Promotion.
"Controversies remain regarding diet-disease links, the magnitude of benefits expected with changing habits, and optimal quantitative advice," said Glanz. "But the potential public benefit from improved eating patterns, coupled with the low risk of adopting present guidelines, provides a stronger foundation than ever before to understand and encourage good nutrition."
"Funding for dietary change programs and research is typically categorized by disease," said Glanz. "This forces researchers into narrow models that limit what information to give and what endpoints to measure. It adds to consumer confusion."
Glanz points out emerging data that show that more Americans have become overweight during the last decade. The percentage of overweight teens increased (from 15 percent to 21 percent), as did the percentage of overweight adults (from 26 percent to 34 percent).
Some progress has been made. The Healthy People 2000 initiative reported a decrease during the last decade from 36 percent to 34 percent in the average percentage of calories from fat in people's daily diets, and a decline in average blood cholesterol level from 213 to 203.
"Motivating people to change will require more aggressive strategies and wider dissemination of effective interventions," said Glanz. In a 1990 study of 2,400 women, those receiving nutrition instruction, behavioral counseling, and feedback cut their calories from fat from 40 percent to 24 percent. They lost weight and reduced cholesterol. If cause-and-effect in similar studies could be confirmed, agreed upon, and shared throughout the scientific community, the public would be better off.
Other developments in healthy eating promotion seem promising. One supermarket study found that consumers doubled their purchases of special diet products when shelf markers nutritionally identified them. Cafeteria patrons in another study tripled their purchases of fruits and salads when offered more variety and reduced prices.
On the medical front, two-thirds of primary care physicians say they personally provide nutrition counseling and rely upon nurses or others for backup. However, few use dietary assessments required for personalized counseling. This may be the result of lack of confidence, training, time, staff, or payment.
Aggressive federal programs are especially lacking, concludes Glanz, who sees an urgent need for efforts aimed at poor and minority populations. "As they promote fruits, vegetables, and grains, policymakers must rise above this country's meat and dairy interests and reach consensus with scientists and agencies," said Glanz.
The American Journal of Health Promotion is a bimonthly peer-reviewed journal solely dedicated to the field of health promotion. For information about the journal call 248-682-0707 or visit the journal's website at http://www.healthpromotionjournal.com.
Posted by the Center for the Advancement of Health http://www.cfah.org. For information about the Center, call Petrina Chong, pchong@cfah.org 202-387-2829.
Journal
American Journal of Health Promotion