Public Policy

2015 Dietary Guidelines for Americans*

There was a lot of uproar the past week or so about the newly published 2015 Dietary Guidelines.  I have to say that I am disappointed in the negative conversation that has been going on for a few reasons:

First, they may not have accomplished everything I was hoping for as a healthcare professional, but the DGA are certainly moving in the right direction (lowering sodium a bit, adding advice on added sugars, loosening advice on cholesterol).

Second, it is meant simply as population advice and not individualized advice.  Please go see a Registered Dietitian to have a meaningful, individualized conversation about your needs and strategies to enact those changes.  The DGA helps set standards for the National School Lunch Program, the National School Breakfast Program, helps guide %DV on food labels, and provides some talking points and guidance for healthcare professionals, but nothing more.

Third, you can do something about it!  You can comment during the next comment period (I certainly did this last go-around) what recommendations feel most important to you.  You can help move the guidelines forward by meeting your basic nutrition needs (yes, actually getting 5+ servings of fruits and veggies every day) so that as the population as a whole gets healthier, the guidelines can become more complex (maybe one day we'll see commentary on ratio of omega 3s:omega 6s).

*Title links to eatright.org's video explaining the DGA.

Happy and healthy eating y'all!

Nutrition Labeling: Time for Change is Now

The Nutrition Facts Panel

The nutrition facts panel is a sorely underused bevy of information for consumers.  It is something that I regularly counsel clients on how to use as a tool and how to apply their individual needs to the information on the panel to make balanced decisions at the point of purchase.  It can be overwhelming to apply at first, but hopefully with some changes to make the label a bit easier to understand, the habit of using labels to impact consumer decision-making will become more routine.

Check out the press release from the FDA regarding the changes: FDA proposes updates to nutrition facts label on food packages 

What's Changing?

  • Serving Sizes and Calories are going to be more reflective of what people are actually eating and more prominently displayed
  • Added Sugars are going to be added to the label under the Sugars (under Carbohydrates) to clearly identify sugars that are not naturally occurring
  • Vitamins A and C are out, Vitamin D and Potassium is in as there are rarely deficiencies in the former, and the latter play larger roles in the development of chronic disease

Other Ideas?

First of all, the comment period is open right now regarding the proposed changes.  If you are interested in making a comment (I made mine!) please visit the following sites:

The Center for Science in the Public Interest (yes, love them!) has been on the forefront of this issue for years now and had come up with an interesting proposal regarding the changes.  See page 10 of this report for the best visual and explanation.  Personally, I prefer their changes to the current changes proposed by the FDA, but I understand that that would require a huge overhaul.  Not only is the FDA careful to not make major changes for fear of further confusing consumers, but many manufacturers are very resistant to these changes.

I honestly feel that the big change that is missing is requiring all sources of sugars to be listed together in the ingredients list to open up consumers eyes to just how haphazardly and insidiously processed sugars are added into the food supply.  I feel that adding them to the label as added sugars is a step, but unfortunately I'd bet we're going to find food manufacturers going the 'route of trans fats' and keeping the limits per serving just low enough to be able to label them as 0g.  There is also no reference for the consumer, so listen up!  The American Heart Association recommends no more than 24 grams daily for women and 36 grams daily for men.

Let's Go RD Community - Get Coverage for Obesity Services!

Treat and Reduce Obesity Act

The Treat and Reduce Obesity Act would allow for qualified health care professionals, typically Registered Dietitians, to bill directly for their Medical Nutrition Therapy and Intensive Behavioral Therapy services.  Increasing access to qualified healthcare professionals helps to reduce the cost of treatment and increase access for obesity treatment provided to Older Americans.  This is a clinically appropriate and cost-effective piece to the puzzle in tring to increase preventive care in our health care system.  I think it is important to ensure that Medicare patients have access to the best possible care at a fraction of the cost.

Medical Nutrition Therapy

The Preventive Services Task Force found that intensive behavioral therapy carried out for obese patients by Registered Dietitians led to clinically significant weight loss, greater weight loss and increase in exercise.  With the obesity epidemic costing our nation $210 billion annually, this is an immensely important issue.  

Go to Grassroots Manager now to write to Congress!

Advocating for our services from the platform of public policy is what will shape the landscape for nutrition services decades from now.  I urge my fellow RDs to log in and help support this bill, as coverage issued by the Centers for Medicare and Medicaid often trickle down to becoming standards of care within the industry.

GMO Labeling: Making History

What is GMO?Photo courtesy of csa.com/discoveryguides/gmfood

Genetically Modified Organisms are anything that is grown using genetic engineering technology.   Genetic engineering means that these products have been modified by scientists to have greater incidence of a specific trait or outcome.  Genetic engineering is more accurate and faster than traditional breeding, but many questions are raised regarding health benefits (or lack thereof), unintended consequences, ecological impact, and intellectual property law.  For example, there are strains of tomatoes that are genetically modified to not ripen as quickly so that they last longer for consumers.  

The FDA reports that there are currently about 45 genetically modified plant varieties in the marketplace.  For more information and interesting statistics please see the Biotechnology section of the USDA Economic Research Service.

A Good Day for Connecticut

Consumers are becoming more informed regarding what GMOs are, and want to have this information available to them while grocery shopping.  Connecticut just became the first state to pass GMO labeling laws (with a unanimous vote in the Senate and 134-3 vote in the House in favor!).  The language in this bill will allow consumers in CT to have greater transparency and make informed decisions.  It does however require four states (at least one of which bordering, ahem) to pass similar legislation.  

It was written this way so that local small farms and businesses were shielded from being at a competitive disadvantage.  I hope that the passing of this bill helps drive momentum for consumer advocacy across the country.  This is soundly written legislation that I am proud to say was driven by the consumer pushing for their own beliefs of full disclosure.

Take Home Message

We'll have to explore the pros and cons of GMOs in another blog post because there's so much more that can be said!  When I was reading some of my old blogs to see if I have discussed GMOs in the past, I came across a blog I had written four years ago now, "What does organic really mean?".   It's funny, I ended that blog four years ago with the same sentiment I planned to write tonight: 

The ultimate goal in this country surrounding food and nutrition isn't necessarily that all consumers make the same food decisions (organic vs. non-organic, fast food vs. slow food) or even that they always make healthy decisions, but rather that they make informed decisions.

Nutrition Policy In the News

 

Big Gulp

The New York City of Department of Public Health put into effect this month a new effort to decrease consumption of added calories from sugary beverages.  Beverages contaning sugar must be sold in servings of 16 ounces or less.  Water and "diet" drinks may be sold in larger quantities.  Research has linked larger portion sizes, plate sizes, and utensil sizes with an increase in caloric consumption.  Subsequently, as the standard cups and plates that fill our cabinets have grown, so have our waistlines. 

Arsenic in Rice

The Food and Drug Administration has an ongoing study regarding arsenic in rice consuption for 1200 products.  Consumer Reports recently put out an article that has raised public attention to this issue.  Rice absorbs trace amounts of arsenic in its natural growing conditions because it is grown in groundwater.  The FDA has found no evidence thus far that causes concern for the level of contamination (1 gram arsenic per 115,000 servings of rice) however they will be completing the study and releasing their final results and a new standard at the end of this year.  Organically grown rice and rice products are proving to have lower levels than inorganically grown.  At this point the take home message remains to moderate rice products in the diet.  Registered Dietitians are also encouraging use of organic products with babies and children as we find that children are susceptible to increased per-kilogram consumption of added chemicals.

 

Public Policy Initiatives That Work

Public Health Strategies for Health  Photos from two separate public health campaigns.

As some or most of you may know, I have always taken a keen interest in public policy (including helping to research and write sodium legislation for MA DPH during grad school!).  I feel that we live in an obesogenic environment and that one of the places to start to change that is through writing policy.  Creating communities that have access to healthful choices and the knowledge to make those choices is very important.

"As a society, we must implement evidence-based, cost-effective public-health interventions without delay -- we now know they work," said Mozaffarian, associate professor of medicine and epidemiology at Brigham and Women's Hospital and Harvard Medical School in Boston.

 

The Most Successful Campaigns

Researchers published in the journal Circulation analyzed over 1,000 studies seeking to tease out the most effective strategies.  Some that made the list are as follows, in no particular order:

 Bans on smoking in public (not to mention the taxing as a financial disincentive)

  • Walkable communities
  • Limitations on advertising unhealthy foods to children
  • Economic incentives that make healthy foods more affordable
  • Direct mandates and restrictions on specific ingredients (ex. trans fats, sodium)
  • Financials incentives for supermarkets to move into food deserts
  • In-school gardening and structured physical activity in school systems

So what are some of the best and worst public health campaigns that you can think of?  Is anyone thankful for or angry about some of them?  I'd love to know your responses..

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For any additional information regarding global initiatives, please visit the World Health Organization's Strategy on Diet, Physical Activity and Health

Menu Labeling Broadening Healthy Options

Posting Calories, Fat, and Sodium

Well it looks like taking an enviornmental approach to the obesity epidemic - which cost the American economy an estimated $117 billion in 2010 - is starting to impact retail and restaurant options.  In a recent study done in Kings County, Washington, consumers are increasing demand for healthier options in response to knowing what it is that they're eating.

“We did find evidence of a decrease in energy, saturated fat, and sodium content after the implementation of menu regulations for items that were on the menu at both time periods,” reports Dr. Bruemmer. “We also saw a trend for healthier alternatives across all entrées over time, but only in the sit-down restaurants.”

Given the reach of the obesity epidemic here in the US, I'm a big believer in the total approach.  I think it is important for us to make the environment in which we live less obesogenic and for consumers to make informed decisions.

 

[Sidenote: I had no good images for this particular blog on hand, so this Rubiks cube of pork and cheese is a small shoutout to my belovedly left-brained brother who turned 22 today.  Happy birthday Derek!]

Response to Centers for Medicaid and Medicare Service

Background Info

For those readers that aren't in the profession, here's a little background information on what's been going on and why it's important in this country's fight against the obesity epidemic:  The Centers for Medicare and Medicaid Service recently announced that it would reimburse specific health professions (MDs, psychiatrists) for billing for Intensive Behavioral Therapy for Obesity in the primary care setting but that it would not reimburse dietitians for this.  The reason that we as a profession are fighting for our rights to bill for this code is because Registered Dietitians are the premiere health care professional trained in counseling for obesity and overweight. 

How it Impacts Healthcare

RDs are the most effective at tailoring a nutrition care plan to each individual and helping them to reduce their weight.  With this memorandum, obese persons with Medicare and Medicaid will have very limited access to dietitians until they have Diabetes (which RDs can currently bill for, along with Chronic Kidney Disease Stage IV and V).  It saddens me that a potentially live-saving preventive service is not going to be able to be offered by myself and other RDs, as we are a group of providers that have been able to produce the best results.  On top of that it is a very needed among those utilizing Medicare and Medicaid.

While I am personally disappointed in this I am and will continue to help in the fight for improved billing for our profession.  Thank you to everyone who aided in signing the White House Petition.  If you're a fellow RD and haven't done so already, please go to the the Grassroots Manager on eatright.org and send your legislators your thoughts on the matter.

And while there's a lot more to delve into on the topic it's too complicated to make into a blog post... feel free to comment and we'll continue the conversation.

 

 

Have Obesity Rates Stabilized?

The Latest Data

The government and public health agencies work in conjunction with one another to collect and quantify data from all over the country in countless areas.  This is what allows us to see trends over the long term in everything from bicycle and motor vehicle safety to drinking behaviors to nutrition and growth.  The subset of this effort for the nutrition and public health policy world is called the National Health and Nutrition Examination Survey (NHANES).

The most recent NHANES data is telling us that the rates of obesity in US adults may be stabilizing.  That may be a slight overstatement as the rates are increasing at a slower rate, but I hope that with public health concerns rising and public awareness of the health consequences of overweight/obesity seeping in we can in fact see this giant ship turn around.  It's fascinating to think that the multi-pronged efforts that are going on may be helping to change the social and physical environments and that those changes are driving changes at an individual level.

Rising Health Care Costs

This comes at a particularly important time as the health care debate continues in the beltway.  The Congressional Budget Office released a report just this week regarding how the weight of Americans has affected health care costs in the US.  From 1987-2007, per capita spending has grown by 65% and 61% for normal weight range and overweight adults, respectively.  In the same time period, per capita health care spending has grown by 111% for obese adults.  These statistics were calculated using the body mass index categories.  

Let's Move

Let's Move Campaign

I watched the press conference live from the White House today announcing the Let's Move Campaign that Michelle Obama has initiated to combat the rising rates of Childhood Obesity.  Kudos Michelle!  With the partnership of athletes, schools, and both private and public organizations to bring together resources and momentum.  

I believe in this mission so wholeheartedly I can't wait to see where this goes right as I enter the field!

Check it out!

 

The Next Big Mover and Shaker

It's All About the Salt

First it was trans fats, then it was calorie labeling, and now the next big hot topic to emerge in the world of nutrition is sodium consumption.  That's right, table salt.  That innocent one half of a pair that sit on most dinner tables.  But it's not that salt shaker's fault!  75-80% of the sodium we consume is in the form of processed foods.  The remainder comes from salt added to our diets due to cooking or added at the dinner table.  

Image courtesy of the American Heart Association

While the salt shaker may be a bad habit for some, it doesn't seem to be the true contributer to our nation-wide problem.  Sodium both increases palatability and shelf life, so we've seen it slowly creep into a lot of our food supply more and more...  Not to mention the fact that it's a lot cheaper than using traditional spices for the food companies.

I don't want to place the blame on the food companies though.  It has been the collective effort of consumer demand, food technology, globalization of the food economy, and their need to meet the bottom line that has driven this trend.  

Why Salt?

Salt is becoming a buzz issue because when we have an excess of sodium in our bodies it causes our hearts to have to work harder to get the blood through our system.  This leads to increased blood pressure, which is directly related to heart disease and stroke.  Heart disease and stroke are the leading causes of death in the United States.  They account for millions of deaths, billions of health care dollars spent, and countless co-morbidities (such as diabetes or glaucoma).  Sodium consumption is a public health problem that is beginning to emerge as an option to combat these chronic diseases.

Photo courtesy of ODP.NSRI

The National Sodium Reduction Initiative is a program that is in it's very beginning phases.  New York City has taken the reins on this issue and partnered with many governments and organizations across the nation.  They are in the beginning phases of assessing the right approach, but look to reduce sodium intake in New Yorkers by 20% over the next five years.  This will be done by partnering with the food industry and working to change the environment of options available to New Yorkers.  While the NSRI is initiative is voluntary (so too were trans fats and menu calorie posting once), the focus is to help food companies reduce sodium across product lines instead of focusing on any given percentage in all foods.  

Beware!

The top foods that contribute sodium to the diet include sauces (check out the labels of the tomato and teriyaki sauces you find yourself purchasing), canned goods, condiments, soups, prepared mixes, and frozen meals or meal replacement options.  

I encourage you to check out the sodium level on some of the foods you're eating!  Are you surprised to read this?  Not surprised?  Do you have any opinion on how we best proceed to solve this problem across the country? 

Please feel free to share.

Falsified Calorie Information?

The Calorie-Menu Debate

New York City instituted a law that requires restaurants to put the calorie content of their foods on the menu.  Since its inception almost a dozen other cities have done the same, and legislation is being considered in the Senate to create national policies instead of leaving it up to local governments.  NYC decided to place calorie content prominently on their menus in an attempt to inform customers, and hopefully eventually slow down the growing rates of obesity, heart disease, and diabetes.  

Dishonesty.

A recent study by Scripps Research Institute brought many of those NYC menu items to independent labs to determine the calorie content of random items.  Each item was tested twice by different labs.  The study found that the calorie counts being reported on the menus did not reflect the numbers found by the laboratories.  Instead, the menus often showed a number lower than those found.  This has been highlighted by an article in the Wall Street Journal.  How are we supposed to make informed decisions if the restaurants aren't meeting us halfway with honesty?  

According to NPD Group, one in five meals or snacks consumed in the U.S. are produced by restaurants, and 59% of restaurant traffic is at chains.  - WSJ Article

With dining out the norm and not the exception, I think it is very important that people have access to the caloric information.  I don't think that means it needs to be displayed on the menu that is handed to you in the restaurant.  However, having the ability to look that up can help people manage any current diseases or conditions, deal with food allergies and intolerances, and possibly stave off unwanted caloric intake.  

 Photo courtesy of Taylor Umlauf with the Wall Street Journal

What Do You Think?

Setting this law into stone nationally is not the answer to the trend of our growing waistlines in this country, but do you think it is a step in the right direction?  Where would you like to see this information displayed?  And do you think it affects your choices in selecting foods to eat at restaurants?