Is the USDA MyPyramid Effective?

The Scary Statistics
Within the United States, roughly 32.7 percent of adults aged 20 and older are overweight, 34.3 percent are obese and 5.9 percent are morbidly or extremely obese. (3). The prevalence of obese (BMI greater than or equal to 30) American adults has grown from 22.9 in the 1988-1994 data collection to 34.3 in the 2005-2006 data collection. Even scarier, the prevalence of extremely obese adults (BMI greater than or equal to 40) has grown from 2.9 to 5.9. (3).

The Purpose of Dietary Food Guidelines and The Attempt to Provide Improved Guidelines for the New MyPyramid
Based upon data and statistics I just reviewed, the number of obese and overweight Americans is growing, but what is being done to educate and inform citizens on proper diet and nutrition to help reverse the growing epidemic of obesity in this country? One answer to that question should be the dietary guidelines that are put in place by the US government. According to the USDA, dietary guidelines for Americans are the cornerstone of federal nutrition policy and nutrition education activities (2). These guidelines are supposed to be in place to promote health and reduce risk for major chronic diseases such as obesity (2). Every five years, the dietary guidelines are updated by the USDA and the Health and Human Services Department. In 2005, the MyPyramid was introduced, and is the most current dietary and nutrition guideline available. This new guideline was supposed to be a dramatic improvement over the previous 1992 food pyramid, addressing some of the major pitfalls of the previous pyramid. The major flaws of the 1992 pyramid included no emphasis on the importance of physical activity in combination with a healthy diet, generalizing that all fats are bad and ignoring the explanation of unsaturated fats versus saturated fats and the implication that all complex carbohydrates are good for you and should make up a large portion of daily diet. (9).

The MyPyramid Misses the Mark
The 13 years between the 1992 dietary guidelines and the 2005 MyPyramid should have been adequate time to produce a much more comprehensive and effective set of dietary guidelines for Americans to use based upon solid evidence, right? Many nutritional and medical experts disagree and some argue that the recommendations from public health organizations are not evidence-based(5). Some experts argue that these government issued guidelines can cause more harm than good and may need to be avoided, such as the case with the incorrect information provided in the 1992 pyramid about all fats being bad. (5). Even though there are beneficial improvements with the 2005 MyPyramid, such as focusing on an individualized approach to diet and adding in the focus on the importance of physical activity, experts still question whether or not the pyramid will be truly effective in positively influencing American consumers' dietary choices (6). Walter Willet, professor of epidemiology and nutrition at Harvard School of Public Health states that "The pyramid tells nothing of healthy food choices." (6). Willet argues further against the pyramid's credibility and effectiveness by commenting that it emphasizes too much dairy consumption (3 cups a day, not specific to sex, age or physical activity), in addition to the lack of informative information about the various types of fats. (6). Another solid argument against the pyramid's effectiveness is the fact that the information is only available by website, ignoring that several Americans still do not have access to the internet. (6). Even though posters and other media materials are available to schools and other institutions, it is really difficult to determine whether or not a full understanding of proper diet is gained from quickly glancing at a public poster.
We all know of the plentiful benefits of consuming adequate fruits and vegetables to help prevent disease. There is plenty of research available that documents the benefits of fruits and vegetables. Furhman devotes the entire book, Eat to live on the benefits of a diet that is mainly plant-based.(4) Yet, Furhman states that only 7% of American calories consumed are from vegetables and half of the vegetables consumed are potatoes, which are the least nutrient dense (4). Sure, the pyramid recommends daily fruit and vegetable intakes by age, gender and physical activity level, but it fails to elaborate on the multitude of benefits that are available from more fruit and vegetable consumption. The MyPyramid also fails to suggest vegetarian or vegan diets as possible healthy dietary options. While the 2005 MyPyramid does now offer serving suggestions in cups versus the 1992 version of simply suggesting servings, the fruit and vegetable consumption in the US has not increased significantly since the implementation of the 2005 dietary guidelines. In fact, CDC reports show that from 2005 (when the new dietary guidelines were introduced) to 2007, the average median percent of those who consume 5 or more fruits and vegetables daily increased only slightly from 23.8% in 2005 to 24.8% in 2007 (1). And sadly, the median percent of those who consume 0 or less than 1 serving per day stayed exactly the same at 4.4% (1).


Arguments In Favor of the MyPyramid Guidelines
Despite the criticism from many, there are still arguments that favor the changes that the USDA has made with regards to the new 2005 guidelines. Despite the negative feedback with regards to most of the information presented mainly on the internet, many argue that the reach to consumers is significant. Nine months after introduction, the MyPyramid website had 1.2 billion hits and 500,000 people had already started using the interactive diet tracker (8). While, fruit and vegetable intake hasn't seemed to increase, the consumption and purchase of whole grains has. According to the USDA's economic research service, the eight weeks following the introduction of the new guide, whole-grain bread purchases went up 12% and brown-rice purchases increased by close to 19%. (8). Other argue that while there are still some flaws with the 2005 guidelines, it is a vast improvement over the 1992 guidelines. The MyPyramid now makes a better distinction between the types of fats, in addition it highlights healthier choices for proteins. In addition, the new guidelines mention the benefits of fruits and vegetables and lowering cancer risk. (9). In addition to the mentioned improvements, MyPyramid attempts to individualize nutrient guidelines, whereas previously, this was not the case.

Conclusion
While, the arguments for the benefits of the US dietary guidelines tout the improvements that have been made, unfortunately, these changes are not going to be enough to make a more significant change in the rising epidemic of obesity and other chronic diseases within the US. There needs to be a complete change in the entire structure and thought process of what constitutes a healthy diet in order for the US to realize a healthier future with less disease and obesity. Adding more whole grains into your diet and exercising for 30 minutes a day are changes that are too small to make a significant impact. Increased nutrition education, availability of cheaper and more easily accessible fresh fruits and vegetables and an overhaul of the school food program are just a sampling of some of the many actions that would need to be taken in tandem
with changing the way Americans view what a healthy diet is. While the changes made with the MyPyramid guidelines are better than previous US dietary guidelines, I believe they are not enough to be sufficiently effective in reversing our declining population health status.

Bibliography

(1) Average fruit and vegetable consumption per day 2007 vs 2005. (2008). Centers for disease control and prevention. Retrieved (2010, May 29) from http://apps.nccd.cdc.gov/5ADaySurveillance/index.asp

(2) Dietary Guidelines For Americans. (2010). United states department of agriculture. Retrieved (2010, May 29) from http://www.cnpp.usda.gov/DietaryGuidelines.htm

(3) Flegal, K.M., Carroll, M.D., Ogden, C.L., & Curtin, L.R. (2010). Prevalence and trends in obesity among us adults, 1999-2008. The Journal of the American Medical Association, 303(3), Retrieved from http://jama.ama-assn.org/cgi/content/full/303/3/235?ijkey=ijKHq6YbJn3Oo&keytype=ref&siteid=amajnls

(4) Furhman, J. (2003). Eat to live: the revolutionary formula for fast and sustained weight loss. New York, NY: Little, Brown and Company.

(5) Marantz, P.R., Bird, E.D., & Alderman, M.H. (2008). A Call for higher standards of evidence for dietary guidelines. American Journal of Preventive Medicine, 34(3), 234-240.

(6) Mitka, M. (2005). Government unveils new food pyramid: critics say nutrition is flawed. The Journal of the American Medical Association, 293(21), Retrieved from http://jama.ama-assn.org/cgi/content/full/293/21/2581

(7) Mypyramid dietary guidelines graphic. (2005). [Web]. Retrieved from http://www.mypyramid.gov/

(8) One year later: lessons from new guidelines and pyramid. (2006, February). Tufts University Health and Nutrition Letter, 4-5.

(9)Willet, W.C., & Stamfer, M.J. (2006). Rebuilding the food pyramid. Scientific American, 16(4), Retrieved from http://search.ebscohost.com.bob.csueastbay.edu/login.aspx?direct=true&db=aph&AN=23628203&site=ehost-live

Preventing Alzheimer's Disease

According to the Alzheimer's Disease report from the CDC, about 5 million people in the US suffer from Alzheimer's disease. The older you get after age 60, the higher your risk for the disease. And the disease ranks in the top ten causes of death in the United States. While heart disease rates are declining, Alzheimer's disease is increasing.

It is truly an ugly disease that steals family members. I know this first hand, because my grandmother died at a relatively young age from the disease. I recall trying to let her know who I was, as she had no idea and I just remember staring into her eyes, which no longer had her soul in them.

While scientists know that age is one leading risk factor for the disease, along with family history, there is still a lot more to learn with what other factors cause Alzheimer's Disease.

The good news is that according to this study published by the The Journal of American Medicine, individuals who participated in higher physical activity and adhered to a Mediterranean style diet, had a lower risk of Alzheimer's Disease. There have been previous studies conducted, where either a Mediterranean style diet or higher physical activity was associated with a reduced risk for the disease, but no study had reviewed the combined effect on risk factor for the disease with both. The study concluded that for those individuals who didn't adhere to to the healthy Mediterranean diet and did not exercise, their absolute risk for the disease was 19% compared to those individuals who both adhered to the diet and participated in high physical activity whose risk went down to 12%. And according to this study, just adhering to the Mediterranean diet, which consists of a higher consumption of nuts, fish,tomatoes, cruciferous vegetables, fruits, dark and leafy vegetables and reduced consumption of high-fat dairy, red meat and butter could be associated with a reduced risk for Alzheimer's.

I know that this information resonates with me and I am willing to adhere to a better diet and continue my daily routine of regular physical activity. But what about the rest of the country? The diet and lifestyle of Americans needs to change for the better before we can realize a decrease in the new cases of Alzheimer's Disease reported each year. More education and awareness campaigns need to happen to get the word out that a healthy lifestyle and diet are necessities to improved future health.

Does Subway really deserve all the healthy hype?

I am a long-time follower of the television show, Biggest Loser. I religiously watch my recorded DVR's every week. I find the stories of the people on the show to be very inspiring. Biggest Loser is motivating to be, especially on days when I may not feel like heading to the gym to get my daily workout in. One look at the contestants' struggles and how they are overcoming them pound by pound is enough to get me off of my butt and on the treadmill.

While I find the show to be a positive move towards reducing obesity in the US, I have to say that I am consistently annoyed every week with the explicit marketing plugs that Bob and Jillian shove in the viewer's faces. At least one brand every week gets it's time in the sun, be it Extra chewing gum, Yoplait yogurt or Jenni-O brand turkey. But, the one brand that the contestants are shown eating together almost every week is Subway. Subway has spent some serious marketing dollars to be a HUGE part of the Biggest Loser show every week. Bob and Jillian swear Subway is the perfect choice for a healthy meal. I, however, do not think that is true.

In my opinion, while I think it's good that there is at least one lesser of the evils "fast food" option for people in the market, I don't really think Subway should described and advertised as healthy. I'm sorry, I don't think that a place that claims to be healthy should be allowed to advertise themselves as such, yet still offer soft drinks, potato chips, cookies, meatball subs and Philly cheese steaks to their customers.

Another factor that weighs into the Subway equation is the "health halo" effect. The positive effect of healthy labeling or claims on a product that decreases calories and adds a healthy perception to the product, thus in turn causing the consumer to overeat. This study highlighted here in the New York Times showed that the people in the study who went to Subway actually consumed more calories than those who went to McDonald's, due to the perception that everything at Subway was a healthy option because Subway advertises it's name as such. In fact many of the people added full calorie sodas and cookies onto their purchases at Subway. Another interesting note from Dr. Chandon, who conducted the study, who happens to be French, was that America in general needs to quit obsessing about good foods versus bad foods and focus more on the amount of food that they are eating and practice portion control. I think that is so true. Most people think that a good meal constitutes being stuffed upon completion instead of just feeling satisfied. Maybe if Americans just stopped automatically listening to whatever marketing slogan is thrown their way and actually thought about their food choices more thoroughly, the "health halo" would not be as much of an issue. Better yet, there should be more focus on educating the public about the benefits of forgoing processed foods in favor of those which don't require a nutrition label, such as fruits and vegetables.

Not Enough Primary Care Physicians In the US: We Can Blame the Pursuit of the Almighty $

I was not surprised when I read this article highlighting the findings from this Duke University analysis about the large difference in income between a primary care physician and a specialist. Surprise! The specialist makes more money. But, more surprising to me was that the specialist makes about twice as much as the primary care physician over the course of their career in the medical field. According to the US Bureau of Labor Statistics, the annual salary difference between a specialist and a primary care physician exhibited the same disparity. Specialists earn a median annual salary of $339,738 and primary care physicians earn a medial annual salary of $186,044. I knew there was a difference in income, but I had no idea it was that significant.

Money talks and apparently, it is speaking volumes to medical students when they are choosing careers as specialists over careers as primary care physicians in the medical field. This is hindering our chances of reducing the already existing and growing shortage of primary care physicians in the US. Not to mention, the shortage of physicians in rural areas as opposed to urban areas. The US Bureau of Labor and Statistics explains in the occupational outlook handbook that while 75 percent of physician care were in metropolitan areas, only 25 percent were located in rural areas.

My question is what is being done to address this huge and growing concern? Well, according to this article in the Wall Street Journal, there are some actions being taken. For one, the new health care reform bill includes a 10 percent Medicare pay increase for primary care physicians. In addition, more medical schools have opened up around the country and some schools that already exist are raising enrollment totals for first-year students. And one school in Arkansas is working to change the attitude of choosing primary care over specialty, in addition, they are asking students to commit to enter rural medicine practice.

While these are all good steps toward a change, they are very incremental in terms of policy change, just as most of the US government's policies are made. One of my ideas for more significant change includes offering medical students who commit to primary care physician careers before they begin attending medical school either a full waiver or partial waiver of their medical school expenses up front. This could help to eliminate the desire of medical students to go into higher paying specialty careers, simply to eliminate their debt. Another idea would be to offer large discounts or incentives to primary care practice doctors on their liability/malpractice insurance premiums, since this is one of the biggest expenses for physicians. While it is encouraging to see that some small steps are being taken to address this issue, so much more needs to be done.

A Small Step in the Right Direction

While reading the latest news on the subject of Health Policy, I came across this article in the New York Times. I was happy to see that Congress has approved some great initiatives that are a small step in the right direction for a positive change in the future health of the US.
First, I'm glad to see that the requirement for chain restaurants to post their nutrition information clearly on their menus is now going into affect across the entire country. I was glad when the law was passed in California in 2008 and I'm even happier that there will now be accountability for chain restaurants nationwide. I honestly have no idea why it took this long to happen in the first place! People should have the right to know what is in the food that they are eating in restaurant, just the same as they know the contents of their food when they purchase it at the grocery store. Whether or not a person chooses to look at the information is their choice, but it should be there none the less. Plus, this could have a small affect on obesity, since so many Americans eat out frequently. According to the article, since New York adopted the law, more customers are choosing lower calorie food choices as a result.
I'm also pleased that health insurance companies will now have to provide vaccines, recommended screenings and preventative care without charging the patient a co-pay or deductible. This is a huge win in my opinion. I can only imagine how many lives could be saved by detecting cancers and other diseases early enough to potentially treat them before it's too late.
Lastly, hurray for the new federal trust fund that is in place to create more bike paths, playgrounds, sidewalks and hiking trails! Increasing accessibility to areas that promote more physical activity, such as hiking trails is a way to get people out and exercising more regularly, thus improving overall health.
While I think that these new initiatives are such a good step in the right direction, there is so much more to be done. Some important actions that need to be taken include increasing education about the benefits of nutrition and physical activity in the schools, providing more access to better food, such as farmer's markets in lower-income areas and stricter regulation on fast food and soft drink industry advertisements.

Are there really nutritional benefits to Organic products?

Sure, I get that I'm not putting additional pesticides in my body, when I pick out the organic produce vs the non-organic produce, which is important, but what about all the talk that organic is the way to go for more nutritional value? I would like to feel like I'm doing my body such nutritional favor when I go for the organic carrots or apples at my local Trader Joe's, to truly justify the extra price that I'm paying. Even though I feel so proud of my produce when it says organic on the label, I always have nagging questions in the back of my mind, is organic food truly more nutritionally advantageous versus the conventional food?

According to an article published by the American Journal of Clinical Nutrition, that reviewed several quality studies, there is no difference in the nutritional quality of an organic produced food versus a conventionally produced food. The studies reviewed included both produce and livestock products. From this article, it seems that there aren't very many quality studies done because out of over 52,000 articles, only 162 of those were actually worthy enough to have been of satisfactory quality.

This article from the Science Daily, highlights the research done by the University of Copenhagen, department of human nutrition, that basically proves the same thing, no real difference in the nutritional content between organic and non-organic. This study reviewed the intake of non-organic and organic produce in animals over a two year period.
While I'm skeptical that it was done on animal subjects versus humans, the article still validates for me that there just isn't enough data out there for me to believe that along with the absence of pesticides on my produce, that I'm also getting an advantage in terms of nutritional value when I buy organic.

I see why consumers tend to be confused and not necessarily convinced that organic food is worth the extra money, especially if they aren't as environmentally conscious. This informational page about organic food from the Maine Organic Farmers and Gardeners Association, seems to be the same type of information that is the most widely-spread about the benefits of organic. The page clearly states that an organically grown pepper will be more healthier and nutritious than a conventionally produced pepper. I believe most people are led to believe that if they buy organic, not only are they helping the environment, which is completely true, but they are also helping themselves with a more nutritious product.

From now on when I buy my organic baby carrots at TJ's, which I will continue to do, I now believe that I'm not buying them for additional nutritional value, but to reduce the amount of pesticides in the environment and in my body.