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A Nutrition Prescription for a Healthier America

By establishing nutrition guidelines for Americans that make healthy choices more accessible and affordable, policymakers have a real opportunity to improve the well being of millions of individuals. It's time to promote a culture of health in our nation.
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By Susan Blumenthal, M.D., M.P.A. and Greeshma Somashekar

Our country is facing an epidemic: Approximately one in three adults and one in six children are obese in the United States. It is estimated that more than 95 percent of Americans will be overweight or obese within the next two decades. For the first time ever, we have a generation of kids who may not be as healthy or outlive their parents. Obesity is a major health issue as well as an economic concern for our nation. Obesity is a risk factor for some of the leading causes of preventable death -- heart disease, stroke, Type II diabetes, and certain types of cancer. The growing chronic disease burden linked to obesity costs our country about $150 billion a year, which represents almost 10 percent of the U.S. health care budget. On average, the annual medical expenses of obese people are $1,429 higher than for their non-obese counterparts.

Good nutrition is an important protective factor against obesity and the preventable diseases associated with this condition. Proper nutrition is also essential for children's growth and development. Maintaining a healthy lifestyle by eating right and getting the recommended amount of physical activity can decrease the likelihood of overweight and obesity. While many individuals and families understand these principles of prevention and the importance of a well-balanced diet, the specifics are not always known. Furthermore, it is often difficult for people to sort through all of the information available about nutrition and food choices as well as to purchase products that are both affordable as well as healthy.

In February 2015, the nation's top health and nutrition experts submitted dietary recommendations for Americans to the Secretaries of the U.S. Department of Health and Human Services (HHS) and the U.S. Department of Agriculture (USDA). The information outlined in the Dietary Guidelines Advisory Committee report includes results from extensive data analyses and peer-reviewed, evidence-based studies. During the upcoming phase of the policy process, the HHS Office of Disease Prevention and Health Promotion, in collaboration with the USDA, will translate the DGAC recommendations into the 2015 Dietary Guidelines for Americans document, which is published once every five years. Policymakers will also take into account input from other experts and comments from the public.

This year's Dietary Guidelines Advisory Committee (DGAC) report focuses on America's "suboptimal" dietary patterns, which have contributed to rising rates of obesity and associated chronic illnesses like diabetes and heart disease. The scientists suggest that Americans need to focus on consuming more whole, minimally processed foods, greater amounts of fruits and veggies, and fewer animal products. They recommend that future policy initiatives should aim to increase the availability of healthy foods and beverages in communities, to produce more informative and user-friendly product labels, and to implement interventions that will encourage customers to select healthier options.

Summary of Topic-Specific Scientific Findings in the DGAC Report

-- Food and Nutrient Intake: Current Status and Trends

Several nutrients (vitamins A/D/E/C, folate, calcium, magnesium, fiber, potassium) were found to be under consumed by Americans relative to the Adequate Intake Levels set by the Institute of Medicine, while two nutrients (sodium and saturated fat) are over consumed by the U.S. population. Although diet quality varies based on the food environment, the average American diet does not meet federal recommendations for consumption of vegetables, fruit, dairy, or whole grains, and exceeds recommendations for refined grains, solid fats, and added sugars.

-- Dietary Patterns and Health Outcomes

Using existing research and data, the DGAC modeled three healthy dietary patterns to examine their nutritional benefits: 1) healthy U.S.-style pattern, 2) healthy Mediterranean-style pattern, and 3) healthy vegetarian pattern. All three of these model diets fulfill the daily nutrition needs of the average person. The major message: Americans should be encouraged to consume diets that are rich in vegetables, fruit, whole grains, seafood, legumes, and nuts; moderate in low- and non-fat dairy products and alcohol (among adults); lower in red and processed meat; and low in sugar-sweetened foods and beverages as well as refined grains.

-- Individual Diet and Physical Activity Behavior Change

The DGAC suggests a diverse range of behavior change strategies that can be used to improve health outcomes for Americans. These include 1) reducing television, computer, and mobile phone screen time; 2) decreasing the frequency of eating at fast food restaurants; 3) increasing the frequency of shared family meals; 4) self-monitoring of diet and body weight; and 5) producing informative, user-friendly food product labels to encourage healthy choices by consumers. These comprehensive lifestyle interventions should be combined with adopting Federal guidance on recommended levels of physical activity. Nutrition counseling can also help some individuals adopt and maintain healthier diets.

-- Food Environment and Settings

Few Americans currently have diets consistent with the existing Dietary Guidelines. Prevention-based nutrition programs that address the social determinants of health and the barriers that exist for eating a healthy diet are rare in communities across the country. Improving the availability of healthy foods in underserved communities would help reduce existing disparities in access to healthy foods. Federal nutrition assistance programs like SNAP and WIC play a key role in this effort and actions are need to ensure that millions of beneficiaries have access to affordable healthy foods that meet Dietary Guidelines recommendations. The DGAC's findings also reveal the power of "multi-sector approaches" over single component and individual strategies. Effective interventions incorporate both nutrition and physical activity in creative ways.

-- Food Sustainability and Safety

The impact of food production, processing, and consumption on environmental sustainability is an area of research that is rapidly evolving. Current evidence reveals that the average American diet has a larger environmental impact (increased greenhouse gas emissions, land use, water use, and energy use) compared to the three healthy dietary patterns mentioned above. Linking health, dietary guidance, and the environment will promote human health and the sustainability of natural resources to ensure current and long-term food security in the 21st century.

Preventable chronic diseases linked to obesity as well as food insecurity that affects 1 in 6 Americans places an enormous social and economic burden on individuals and our nation. Collaboration across the public and private sectors can help communities provide healthier food choices, expand opportunities for physical activity, and protect the environment as well. By establishing nutrition guidelines for Americans that make healthy choices more accessible and affordable, policymakers have a real opportunity to improve the well being of millions of individuals. It's time to promote a culture of health in our nation. The upcoming Dietary Guidelines for Americans report should serve as an important ingredient in the recipe for a healthier America in the years ahead.

Rear Admiral Susan Blumenthal, M.D., M.P.A. (ret.) is the Public Health Editor of The Huffington Post. She is a Senior Fellow in Health Policy at the New America Foundation and a Clinical Professor at Tufts and Georgetown University Schools of Medicine. She is also Senior Policy and Medical Adviser at amfAR, The American Foundation for AIDS Research. Dr. Blumenthal served for more than 20 years in senior health leadership positions as a leading expert in the federal government in the Administrations of four U.S. presidents including as Assistant Surgeon General of the United States, the first Deputy Assistant Secretary of Women's Health, and as Senior Global Health Advisor in the U.S. Department of Health and Human Services. She also was a White House Advisor on health. Prior to these positions, Dr. Blumenthal was Chief of the Behavioral Medicine and Basic Prevention Research Branch, Head of the Suicide Research Unit, and Chair of the Health and Behavior Coordinating Committee at the National Institutes of Health. She has chaired numerous national and global commissions and conferences and is the author of many scientific publications. Admiral Blumenthal has received numerous awards including honorary doctorates and has been decorated with the highest medals of the U.S. Public Health Service for her pioneering leadership and significant contributions to advancing health in the United States and worldwide. Named by the New York Times, the National Library of Medicine and the Medical Herald as one of the most influential women in medicine, Dr. Blumenthal was named the 2009 Health Leader of the Year by the Commissioned Officers Association and as a Rock Star of Science by the Geoffrey Beene Foundation. She is the recipient of the Rosalind Franklin Centennial Life in Discovery Award.

Greeshma Somashekar is a junior at Stanford University, pursuing a degree in Human Biology with a concentration in Medical Journalism. She is a Health Policy Intern at the New America Foundation in Washington, D.C.