The 2010 Dietary Guidelines for Americans: Process and Recommendations Robert C. Post, PhD, Med, MSc...

The 2010 Dietary Guidelines for Americans: Process and Recommendations

Robert C. Post, PhD, Med, MScDeputy Director

Center for Nutrition Policy and PromotionUnited States Department of Agriculture

Linda Van Horn, PhD, RDProfessor, Department of Preventive Medicine

Feinberg School of MedicineNorthwestern University

Transforming Leadership, Policy, and Practice9th National Forum for Heart Disease & Stroke Prevention

September 22, 2011

Challenges We FaceThe Heavy Toll of Diet-Related Chronic Diseases

81.1 million Americans—37% of the population—have cardiovascular disease

74.5 million Americans—34% of adults—have hypertension and 36% of adults have pre-hypertension

Nearly 24 million adults—11% of adults—have diabetes

About 41% of the population will have cancer during their lifetime

One out of every 2 women and 1 of 4 men will have an osteoporosis-related fracture in their lifetime.

Robert C. Post, Center for Nutrition Policy and Promotion, USDA

Dietary Guidelines for AmericansHistory 1980 – 2010

1980

1985

1990

1995

2000

2005

2010

What are the Dietary Guidelines for Americans?

• Since 1980, Federal nutrition policy established jointly by USDA & HHS

• Updated every 5 years• Provide science-based advice for ages 2 and over, including those at

increased risk of chronic disease to promote health• Foundation for Federal nutrition programs, nutrition education

programs, nutrition promotion, and a basis for research gaps and priorities

• Ensure that messages and materials are consistent through-out the Federal government and that government speaks with “one nutrition voice”

• Policy used by educators, health professionals, policy makers – in public and private sector – applied and amplified in guidance, standards, education, outreach for consumers


Goals of Dietary Guidelines

• Define a healthy diet • Provide healthy options• Promote healthy choices• Increase public awareness and demand for choices • Stimulate innovation for re-formulating food

products and creating healthier ones• Strengthen the collaboration between food

scientists and nutritionists


Development of Dietary Guidelines Policy and Communications

DGAC Report Submitted to

Secretaries of USDA & HHS

USDA & HHS Develop

Policy Document

DGA’s Implemented through Federal

Programs

DGAC Charter

DGAC Public Meetings: Review of

Science

Four- year process to develop the DGA

Phase 2

Phase 1

Phase 3 Phase 4

USDA’s Nutrition Evidence Library

www.NutritionEvidenceLibrary.gov

2010 DGAC Report

Food pattern modeling

Other systematic reviews/reports:

• PA Guidelines• DRIs• Federal Reports• Others

Dietary intake analyses

(e.g., consumption trends/calorie intake by

groups )

2010: Landmark Advances in Access to and Evaluation of Nutrition Literature

Public Comments

http://www.nutritionevidencelibrary.gov/

Nutrition Evidence Library (NEL) Evidence-Based Methodology

Rigorous

Minimizes bias

Transparent

Accessible to stakeholders/consumers

Defines state of the science

Foundation for updates

Answers precise questions – Illuminates research gaps

www.NutritionEvidenceLibrary.gov

Public Comments

Public comments—written and oral– Throughout the DGAC deliberation process, as well as after the

release of their Report– Available online at www.dietaryguidelines.gov – Over 100 organizations or individuals provided oral testimony at

public meetings• To the DGAC on their work or • To the government on the DGAC’s final Advisory Report

– Over 1100 written on the Advisory Report alone– Comments taken into consideration as part of the development

process for both the Advisory Report and the policy document USDA and HHS Agencies reviewed Advisory Report for

potential program-specific policy implications

All comments available for viewing at www.dietaryguidelines.gov

http://www.dietaryguidelines.gov/

Dietary Guidelines Development Process

Drafting and Vetting of The Dietary Guidelines Writing team:

– USDA and HHS nutritionists -- most who worked closely with the DGAC in developing the Report

– Structure for DGA followed the four main integrated findings identified in the DGAC Report’s Translation and Integration Chapter

Reviews of policy document drafts:– USDA and HHS Agency review for policy implications– Independent peer review for compliance with Quality of

Information Act for clarity, technical accuracy, and consistency with the Advisory Report

– Clearance through the Departments in December 2010

Transparency and inclusiveness through review process

2010 Dietary Guidelines at a Glance

• Executive Summary• Chapter 1. Introduction• Chapter 2. Balancing Calories to

Manage Weight • Chapter 3. Foods and Food

Components to Reduce • Chapter 4. Foods and Nutrients to

Increase• Chapter 5. Building Healthy Eating

Patterns • Chapter 6. Helping Americans

Make Healthy Choices • Appendices

Linda Van Horn, Northwestern University

2010 Dietary Guidelines Highlights

Policy Document– Includes 23 key recommendations for the general

population and 6 for subpopulation groups– Organized to present information in an integrated

way Two Overarching Concepts

– Maintain calorie balance over time to achieve and sustain a healthy weight

– Focus on consuming nutrient-dense foods and beverages


2010 Dietary Guidelines Concept:Balancing Calories to Manage Weight

• Epidemic of overweight and obesity in all segments of our society

• Environmental factors contribute to weight gain

• Calorie balance over time is key

• Important modifiable factors

• Calories consumed in foods and beverages

• Calories expended in physical activity

• Strong evidence for no optimal proportion of macronutrients for weight loss


Top Sources of Calories Among Americans 2 Years and Older

1. Grain-based desserts (6% of calories)• Cake, cookies, pie, cobbler, sweet rolls, pastries, and donuts

2. Yeast breads (6% of calories)• White bread and rolls, mixed-grain bread, flavored bread, whole-

wheat bread, and bagels

3. Chicken and chicken mixed dishes (6% of calories)• Fried and baked chicken parts, chicken strips/patties, stir-fries,

casseroles, sandwiches, salads, and other chicken mixed dishes

4. Soda/energy/sports drinks (5% of calories)• Sodas, energy drinks, sports drinks, and sweetened bottled water

including vitamin water

5. Pizza (5% of calories)Approximately 28% of total calories!


Principles for Promoting Calorie Balance in Food and Beverage Intake

• Self-monitor food and beverage energy intake, physical activity, and body weight

• Reduce portion sizes

• When eating out, make better choices / reduce portions

• Limit screen time

• Make more nutrient-dense choices; nutrient dense breakfast. Reduce /omit energy dense/ nutrient poor choices.

• Know calorie needs and limit intake

• Place individual food choices into total diet/overall eating pattern


2010 Dietary Guidelines Concept: Focus on Consuming Nutrient-Dense Foods

and Beverages Reduce intake of foods and beverages high in solid fats,* added

sugars, and sodium (snacks, desserts, SSBs)– Replace with nutrient-dense foods and beverages

Nutrient Dense foods include: – Vegetables and fruits– Whole grains– Fat-free and low-fat dairy products– Seafood (reduces lean meat/poultry in food patterns))

Choose nutrient dense foods, but stay within calorie needs

*Solid fats are major sources of saturated fats, trans fats, and cholesterolLinda Van Horn, Northwestern University

Foods and Food Components to Reduce - Sodium

Current Average intake = 3440 mg/day• Reduce intake to less than 2300 mg per day • Further reduce intake to 1500 mg per day for

•Adults ages 51+•African Americans ages 2+

• People ages 2+ with high blood pressure, diabetes, or chronic kidney disease

• The 1500 mg recommendation applies to half the total population (ages 2+) and to the majority of adults

• Immediate, deliberate reduction in sodium content of foods is needed


Food Sources of Sodium


Foods and Food Components to Reduce

Current average intakes: Total fat 34% of caloriesSaturated fat 11% of caloriesCholesterol 350 mg/ day for men & 240 mg/d for women

Recommendations: Saturated fatty acids—less than 10% of calories

Less than 7% reduces risk of CVD further

Replace with poly- and monounsaturated fatty acids (not with sugar or refined grain)

Trans fats—as low as possible

Cholesterol—less than 300 mg per day Effect on CVD small compared to saturated and trans fats

Egg yolks (25mg cholesterol?) —up to 1 per dayLinda Van Horn, Northwestern University

Food Sources of Saturated Fats


Calories from solid fats and added sugars

Currently, solid fats and added sugars (SoFAS) provide 35% of calories/ day, but do not contribute nutrients

Recommendations:

■ Reduce intake of calories from SoFAS

■ No more than 5 to 15% of calories from SoFAS can be accommodated in healthy diets

■ As the amount of solid fats and/or added sugars increases, the intake of sufficient dietary fiber and essential vitamins and minerals decreases within calorie limits. Linda Van Horn, Northwestern University


Refined grains■ Average intake is 6.3 oz-eq/d

■ Recommended level no more than 3 x 1oz-eq/d (2000 calorie level in the USDA Food Pattern)

■ Limit consumption of refined grains, especially those that contain solid fats, added sugars, and sodium new

■ Enriched refined grain products provide some vitamins and minerals, but not the fiber provided by whole grains

■ Replace refined grains with whole grains


Food Sources of Refined Grains

Comparison of Consumption to Recommendations


Summary2010 Dietary Guidelines for Americans

• Evidence-based nutritional guidance

• Promote health

• Reduce the risk of chronic diseases

• Reduce the prevalence of overweight and obesity

• Integrated set of advice for overall eating pattern

Resources• www.DietaryGuidelines.gov

• Policy document/Q’s and A’s, selected consumer messages

• Advisory Committee Report

• www.NutritionEvidenceLibrary.gov


Applications of the 2010 Dietary Guidelines


2010 Dietary Guidelines: Applications

USDA• Food and Nutrition Service

– SNAP (formerly Food Stamps)– WIC– National School Lunch Program

• Food Safety and Inspection Service– Nutrition Facts labeling– Food safety education

• Center for Nutrition Policy and Promotion– USDA Food Plans (Thrifty, Low-cost, Liberal)– USDA Food Patterns– Healthy Eating Index (HEI)



HHS• Centers for Disease Control and Prevention

– Fruits & Veggies – More Matters

• Food and Drug Administration– Front of pack and other nutrition labeling

• National Institutes of Health– WECAN!– NHLBI’s DASH Eating Plan

• Office of Disease Prevention and Health Promotion– Healthy People 2020



Public & Private Sectors• Non-profits

– Develop materials that translate the Guidelines for their areas of expertise with focus for target audiences

• Food industry– Ex. Lower sodium food formulations

• Community coalitions– Nutrition education where Americans live, work, and play

• Teaching Institutions– Public and professional education for translating the Guidelines

for the public


DGA selected

messages for

consumers released

Nutrition Communicator

s Network launched

MyPlate unveile

d

January 2011

June2011

September 2011

and beyond…

MyPlate multi-modal

communications initiative launched

New Dietary Guidelines Lead to a New Symbol for Thinking About Healthy Eating


2010 Dietary Guidelines for

Americans (DGA) released

What the Icon Is

■ A new take on a familiar mealtime symbol.

■ A cue to help consumers think about making healthy choices.

■ Symbolizes a need to build a healthy plate based on the food groups.

■ Will be accompanied by a broader effort to help consumers choose a healthy diet.

The MyPlate Icon


Multi-modal ApproachCoordinated Messaging, MyPlate icon, and

“How-tos”

Partnerships

Social Media and “Buzz” Activities

Interactive Tools and Resources to Apply the DGA @ ChooseMyPlate.gov

Th CampaignA multi-modal approach is needed to sustain momentum and ultimately change behavior.

The MyPlate Campaign


Dates 2010 DGA Theme Selected Key Message

Sept. – Dec. 2011 Foods to Increase Make half your plate fruits and vegetables.

Jan. – April 2012 Balancing Calories Enjoy your food, but eat less.

May – Aug. 2012 Foods to Reduce Drink water instead of sugary drinks.

Sept. – Dec. 2012 Foods to Increase Make at least half your grains whole grains.

Jan. – April 2013 Balancing Calories Avoid oversized portions.

May – Aug. 2013 Foods to Reduce Compare sodium in foods like soup, bread, and frozen meals – and choose the foods with lower

numbers.

Sept. – Dec. 2013 Foods to Increase Switch to fat-free or low-fat (1%) milk.

Release a multi-year strategy to coordinate and streamline messages to the public.

Selected DGA Consumer Messages: Campaign Calendar

Demonstrate how consumers can apply the Guidelines to their lives.

• “10 Tips Nutrition Education Series”

• Consumer Brochure

• Posters

• Videos and video competition

• Menus

• Recipes

• Online Information and Interactive Tools

“How-tos” to Fit Every Lifestyle


Nutrition Communicators Network provides and amplifies how-tos for consumers!

A partner category for every organization:

• Community Partners

• National Strategic Partners

Partnerships

Underscores the importance of reaching consumers BOTH on a community level and a

national level!Robert C. Post, Center for Nutrition Policy and

Promotion, USDA

ANNOUNCING:■ MiPlato and Spanish language materials■ Consumer video competition launch■ SuperTracker Tool■ Redesigned ChooseMyPlate.gov website■ Campaign and partnership milestones

What’s New on MyPlate?


■ Important in developing and disseminating how-tos to help various audiences apply the DGA consumer messages

■ Imagine the potential impact on consumer behavior if the entire health community focused on one message/behavior at a time……….

The Nutrition/Health Community


Promote 2010 Guidelines messages with USDA through timed, coordinated releases

Use new MyPlate food icon

Drive consumers to the tips, resources, and tools at ChooseMyPlate.gov

Supplement the 2010 Guidelines messages with how-tos that appeal to your audience

Become a Community Partner

What You Can Do


• Link to ChooseMyPlate.gov and web materials

• Feature MyPlate icon on website and materials

• Develop public service announcements

• Produce ChooseMyPlate.gov placemats

• Create videos • Coordinate challenges or

contests in your community • Showcase your work at

individual message launches

• Use social media to get the word out

• Develop mobile applications • Create educational materials,

resources, curriculum, and tools • Share healthy MyPlate photos

and pictures • Create recipes/menus following

the Dietary Guidelines • Feature messages in advertising,

point-of-purchase, and media • Evaluate message dissemination

and/or program reach

Ideas for Getting Started Now


■ Expansive delivery of solid evidence-based recommendations

■ Consistent, sustained communication using relevant messages is key in helping consumers achieve healthy diets and lifestyles

■ Dietitians and other health professional partners are vital to empower consumers and reach diverse audiences with how-tos that resonate

■ Evaluation will be vital!

Desired Outcomes


Questions?



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The 2010 Dietary Guidelines for Americans: Process and Recommendations Robert C. Post, PhD, Med, MSc...

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