Statement highlights:
• A new scientific statement from the American Heart Association offers specific steps to implement good nutrition for families, schools, worksites and communities.
• Strategies to improve America’s diet should be comprehensive and should consider individual tastes and behavior, familial eating patterns, social/economic constraints of food choice, ethnicity and literacy levels.
• Healthcare providers are urged to take a more holistic counseling approach to dietary behavior change in patients, rather than just authoritatively telling them what to do.
 
DALLAS, March 2, 2009 – Every level of society should address barriers to heart-friendly nutrition and undertake specific strategies to make it easier for people to follow healthy eating patterns to reduce heart disease risk, according to an American Heart Association statement published in Circulation: Journal of the American Heart Association. The statement is a call to action of specific strategies to implement nutrition guidelines established by the association in 2006.

View Implementing American Heart Association Pediatric and Adult Nutrition Guidelines.

“Health problems caused by the U.S. diet extend past what people put on their plates to outside influences and trends in behavior that affect when, what and how much people eat,” said Samuel S. Gidding, M.D., chair of the statement writing committee and director of Pediatric Cardiology at Nemours Cardiac Center of the Alfred I. Dupont Hospital for Children in Wilmington, Del. “Multiple factors influence what Americans eat at every stage of the life cycle.”

On the individual level, people are influenced by genetics, personal history and culture, among other factors. Within the family, parents serve as role models and determine what children eat, how and when they eat and what foods are available. At the community level, choices are influenced by what food is available at the workplace, at school, in restaurants and at the grocery store. On a broad societal level, government policies, laws, media, industry relations and transportation also impact food choices.

“Negative trends contributing to the obesity epidemic include eating too many calories — often by way of too many snacks or oversized restaurant food portions — and drinking too many sugary beverages,” Gidding said. “Nutrition remains a cornerstone in the effort to prevent cardiovascular disease, especially early in life, and addressing those negative trends at every level is essential to good health.”

For families
Individuals and families face many barriers to a healthier diet, including complex lifestyles and work schedules, the fact that many meals are prepared outside the home and there is often the need for multiple caregivers for children. These can be further influenced by financial and accessibility factors.

However, people can steer away from unhealthy meals in restaurants by making good food choices. They can also use their purchasing power at the store to avoid high-sugar foods that are heavily marketed with licensed cartoon characters and they can buy fresh or frozen fruits and vegetables, whole grains, low fat dairy products, beans (legumes) and fish, including fresh, locally grown foods, Gidding said. “Parents and others in society can be role models for children in making these decisions.”

Ideally, every visit to a healthcare provider would include determining weight and body mass index (a measure of fatness), followed by a discussion of the patient’s eating pattern and how to improve it, according to the statement. Healthcare providers may have more success if behavior based intervention are incorporated into nutrition counselling sessions. These include the patient’s self-assessment of how they can change adverse eating behaviors.

Specific strategies might include asking patients to measure consumption and then limit the use of sugar-containing beverages, reduce portion sizes, increase the frequency of eating meals as a family and schedule time for physical activity.

Rather than just specific diet counselling, doctors should support lifestyle intervention and provide positive feedback for success that balances the many negative messages about risk often conveyed in an office visit, Gidding said.

At school and work
Studies show that using a multi-faceted approach to change the school nutrition environment simultaneously is the most effective. Strategies that work include strengthening nutrition standards in schools and industry reformulation of food products marketed to children. An ongoing effort at the local level by parents and lawmakers is needed to help adopt healthier standards in all schools.
Workplace interventions with the best chance of affecting change in how people eat are those that are longer-term and Web-based, compared to one-time-only interventions and printed literature. Employers should promote and possibly subsidize healthy offerings in meetings, on-site cafeterias and vending machines.

Government can make a difference
Another way to enable consumers to make healthy choices are food-labeling laws such as the one that recently took effect in New York City requiring many restaurants to post the calorie count of the food they serve. “That makes it easier for customers to order lower-calorie food or share high-calorie dishes with dining companions,” Gidding said.

Policymakers could make healthy foods more available to low-income populations through increased funding for food stamp programs that can be used at farmers’ markets, as well as by creating transportation solutions to provide better access to healthy food.

Also on the community level, governments could provide subsidies to encourage agricultural production of more whole-grain products, trans fat-free oils, low-fat dairy products, fruits and vegetables.

Finally, the guidelines recommend more research on ways to make healthy foods more preferred, perhaps through economic incentives that guide consumers toward healthier choices.

“The adverse trends in U.S. eating patterns must be reversed,” Gidding said. “Food choices are influenced on multiple social and environmental levels. With so many consumers eating away from home, we must make it easier for them to choose healthy food in every environment.”

American Heart Association diet and lifestyle goals include:
• Maintaining a healthy body weight and appropriate blood lipids (fats), blood pressure and blood sugar levels;
• Engage in regular physical activity
• Avoid tobacco
• Limit consumption of dietary calories, salt, saturated fat, trans fat and cholesterol
• Consume a diet rich in vegetables and fruits, whole grains, low-fat and nonfat dairy products, lean meat and fish at least twice a week.

“The goal is to have a more structured eating pattern,” he explained. “You should eat regular meals — breakfast, lunch and dinner. One snack a day is plenty.”

Co-authors include: Alice H. Lichtenstein, D.Sc.; Myles S. Faith, Ph.D.; Allison Karpyn, Ph.D.; Julie A. Mennella, Ph.D.; Barry Popkin, Ph.D.; Jonnelle Rowe, M.D.; Linda Van Horn, Ph.D., R.D.; and Laurie Whitsel, Ph.D.

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NR09-1037 (CIRCULATION/Gidding)
 

Additional resources:
• Making healthy food decisions is an important step in reducing heart disease and stroke risk. The American Heart Association offers a number of important tools and information resources to help. Visit www.americanheart.org/nutrition for more information.

• It’s never too early to start learning about eating right and being physically active. The Alliance for a Healthier Generation — a joint initiative of the American Heart Association and the William J. Clinton Foundation — works to help kids take control of their health and learn the basics of healthy eating. Learn more at www.HealthierGeneration.org.  

• The American Heart Association's heart-check mark can help you choose foods low in saturated fat and cholesterol at your grocery store. The Food Certification Program can be used by those who are looking to reduce their risk of heart disease and stroke, and for patients under the guidance of a healthcare professional. Learn more at www.heartcheckmark.org.

• Cooking heart healthy at home is another way to improve your overall diet. Enjoy heart-healthy cooking with American Heart Association recipes and cookbooks at www.americanheart.org/cookbooks and http://americanheart.org/presenter.jhtml?identifier=3060793.

• Make heart-healthy menu selections at any restaurant with the American Heart Association’s “Tips for Eating Out” at http://www.americanheart.org/presenter.jhtml?identifier=531.  

• Shaking your salt habit can help lower your blood pressure and reduce your risk of heart attack and stroke. Learn how to avoid sodium in your diet by visiting http://www.americanheart.org/presenter.jhtml?identifier=2106.

• Eating a heart-healthy diet can help you control your cholesterol and lower your risk of heart attack and stroke. Learn more at http://www.americanheart.org/presenter.jhtml?identifier=1510.  

• The My Fats Translator tool calculates your personalized daily fat limit and translates it from a percentage into grams of trans fat, saturated fat and total fats. Find out what’s right for you by visiting www.americanheart.org/myfatstranslator.

• Learn about the bad fats and better fats by downloading the free Face the Fats pocket guide at www.americanheart.org/facethefats. This pocket guide is small, so you can keep it close while grocery shopping, eating out or cooking at home.