Friday, May 30, 2014

Stirring the (policy) pot: nutrition and dietary guidelines

At first glance, federal nutrition policy seemed to be an unusual topic for our Georgetown Health Policy Seminar for family physicians. As described in a recent JAMA Internal Medicine editorial, future doctors receive little formal instruction about healthy dietary habits. An accompanying commentary noted that to promote effective change, nutritional education in medical school should encompass much more than memorizing facts about biochemistry and metabolism:

Medical students and residents must also develop competence in the interpersonal and communication skills needed to counsel patients about behavior change and to perform motivational interviewing. ... They must learn to work in interprofessional teams with dietitians and other skilled health professionals to help patients make needed dietary changes. ... Just as medical students and residents must be taught to become antismoking advocates, they need to be taught how to advocate for healthier food environments as part of their role as future physician-citizens.

The USDA Food Pyramid, circa 1990.

Every five years beginning in 1980, the U.S. Department of Agriculture (USDA) and the Department of Health and Human Services (HHS) have jointly issued the Dietary Guidelines for Americans, which serve not only to help citizens make healthy dietary choices but also to guide federal programs that support school lunches and supplemental nutrition assistance for low-income individuals and families. However, a recent analysis suggested that adhering to recommendations of the 2010 Dietary Guidelines to consume more potassium, dietary fiber, vitamin D, and calcium would add hundreds of dollars to an average person's annual food budget; potassium alone would add $380. In contrast, increasing intakes of saturated fat and added sugar are associated with lower food costs.

Current (2010) U.S. Dietary Guidelines.

Last year, former U.S. Secretaries of Agriculture Dan Glickman and Ann Veneman argued in Health Affairs that there is a "disconnect" between federal food and farm policies and evidence-based dietary recommendations:

On one hand, with obesity-related health costs rapidly rising, the federal government has encouraged people to make healthy dietary choices through efforts such as Let's Move! and MyPlate. On the other hand, the federal government spends billions of dollars on traditional agricultural commodity programs that fail to reinforce the kind of healthy dietary choices outlined in federal dietary guidelines.

Providing greater access to nutritious food options at affordable prices doesn't mean that people will purchase them, but is a necessary first step in realizing the potential of nutrition policy to reduce obesity and improve population health.


This post first appeared on The Health Policy Exchange.