Why Can't We All Just Eat Healthy?

By law, the USDA and the Department of Health and Human Services (HHS) team up every five years to evaluate the Dietary Guidelines for Americans. The guidelines are the set of nutritional rules that lie behind the federal government's food programs, including the National School Lunch Program; the Special Supplemental Nutrition Program for Women, Infants, and Children; the Healthy People initiative; and the Food Pyramid, to name a few.

The work of revamping the guidelines falls on the Dietary Guidelines Advisory Committee (DGAC). The committee is a group of 13 nutritionists, scholars, and scientists who will spend this year debating the state of nutrition in the United States and then issue recommendations to the secretaries of HHS and USDA in 2010.

The committee's 2005 report was a sweeping indictment of sedentary lifestyles, fad diets, and poor nutrition practices. It also indicated weak communication between healthcare providers and their patients, as well as between food companies and their consumers. The committee recommended an overhaul of the previous guidelines because "evidence exists that following the existing guidelines would result in dietary patterns that are nutritionally inadequate."

Consequently, the three-meals-a-day message was scrapped. Specific nutrients were investigated, including the effects of carbohydrates on blood sugar, insulin, and obesity. Serving sizes were defined in grams rather than in cups, to help people estimate portion sizes. Multivitamin supplements were recommended, but supplements were only discouraged in favor of nutrients consumed through fruits and vegetables.

That was then, this is now. The committee has met three times in 2009. What has emerged is the surprisingly frank recognition that consumers are thoroughly confused about nutrition, and how they buy, prepare, and consume food is an incredibly complicated and illogical process.

If the committee continues to encourage open dialogue, if the myriad special interest groups striving to influence the committee are held at bay, if the USDA and HHS resist their bureaucratic impulses, then the new Dietary Guidelines will be useful. If not, the government and the food industry will confuse consumers for years to come.

QUOTE OF THE MONTH

"Essentially, the calculus has changed, so it's just easier and cheaper to engage in behaviors that promote obesity and more difficult to engage in those behaviors that are associated with fitness." - Eric Finkelstein, PhD, health economist for Research Triangle Institute, in a NewsHour interview on July 27

There are encouraging signs that the 2010 report will be different. At the April 29 meeting, Dr. Adam Drewnowski, director of the Nutritional Sciences Program at the University of Washington (Seattle), and an obesity expert, asked the simple but meaningful question: Why do people buy and eat certain foods? More specifically, what can be done to bring affordable nutrient-dense foods to people with small food budgets?

Apart from nutrition, Drewnowski studied the relationship between nutrients, energy content, and price. Nutrient-dense foods are relatively expensive. High-energy, low-nutrient foods are relatively affordable. Drewnowski found that when food budgets are tight, people do not cut calories. Instead, they compensate by consuming less-expensive, high-energy products containing fewer nutrients and unfortunately more fats and carbohydrates.

Drewnowski also found that the choice does not have to be one or the other. Food products of all prices are available within each energy range. There are choices besides sugary high-fat foods within each price group. The problem is educating people to find and use them.

The problem may be insurmountable. Food habits are ingrained early, and the choices we make are determined by more than just a quick glance at a food label. As consumers, we carry a lifetime of programming with us to the supermarket along with our grocery list. It's refreshing to see a government-sponsored advisory group include the social and economic factors that influence purchasing decisions into its agenda. There's hope that something more useful may come of the 2010 Guidelines than a fancy new food pyramid.