The advisory committee in June handed the federal government its recommendations for new dietary guidelines and wants to wage all-out war on obesity—not simply suggest, as earlier guidelines have, that Americans eat more of this (veggies and whole grains) and less of that (salt and fat), reports U.S. News & World Report. Key recommendations from the 13 prominent medical and scientific researchers and leaders in their fields across America include:
Think total diet
A concrete but flexible diet is more likely than one that is vague and rigid to succeed over time. Rather than saying that less than 10 percent of calories should come from saturated fat, the panel's guidelines promote nutrient-dense foods that are also low in saturated fat, such as whole-grain bread, produce, skim milk, and poultry, and discourage but never impose a total ban on foods like full-fat cheese, pizza, french fries, ice cream, and bacon. "A healthful total diet is not a rigid prescription, but rather is a flexible approach that incorporates a wide range of individual tastes and preferences," the panel wrote.
Salt is out, potassium in
To bring down the 70 percent of the adult population with hypertension, or high blood pressure, the recommended daily maximum for salt should be slashed to 1,500mg from the current 2,300mg. The lower number already is the suggested ceiling for Americans who are middle-aged or older or African-American, or who already have been diagnosed with high blood pressure. Raising the blood level of potassium is another way to lower blood pressure, and many Americans don't get enough from foods like raisins, figs, and bananas; the panel recommends more than doubling the currently suggested 2,000mg a day to 4,700mg.
All fats aren't evil
Mono- and polyunsaturated fats and omega-3 fats found in many cold-water fish are healthier substitutes for solid fats like butter, shortening, and animal fat. More fish and small quantities of unsalted nuts are recommended. So is dark chocolate, as evidence is building that it reduces blood pressure.
Low carbs vs. low fat: no winner
A "moderate body of evidence" fails to demonstrate that one or the other was superior for losing weight and keeping it off, the panel concludes. Eating less, the advisors note, is the only tried and true way to lose weight. They do find that high-quality protein from sources such as lean meats, poultry, eggs, and seafood can initially help pounds come off by quelling hunger, but they cite studies showing that over time the amount of protein in different diets has no bearing on weight loss or maintaining it.
Tofu and other veggie-based proteins aren't magic
Claims of unique health benefits of vegetable and soy protein aren't backed by good evidence, but the panel notes that these sources do add dietary fiber, and most Americans don't eat enough fiber-rich foods.
Americans should know how much they should eat
"If you ask any American how many calories they need on a given day, most of them are clueless," says Linda Van Horn, chair of the advisory committee. The panel believes that if people had a better sense of that, and of how many calories they take in, the obesity epidemic might be slowed. So the 2010 guidelines, says Van Horn, must offer effective, consumer-friendly tools to help individuals come up with reasonable estimates, personalized according to age, sex, and level of physical activity. The report does not propose a form for those tools.
Treat kids and pregnant women as special groups
Previous guidelines lumped all children ages 2 and up with adults and didn't address pregnant women separately. The advisors want the dietary needs of infants, children ages 2 to 18, and pregnant women treated separately. While all groups need to eat less overall, pregnant women need to seek out foods rich in folate and iron, while kids should give up soda for milk to bolster levels of vitamin D and calcium, nutrients essential for healthy bones.
Tackle childhood obesity before birth
"The only effective way to combat obesity is to never develop it in the first place," says Van Horn. Promoting nutrition and exercise when kids are young isn't enough. The report cites evidence from the Institute of Medicine that mothers who are obese when they are pregnant put their child at a greater risk of following suit when they get older. Prevention, the advisors said, must start in utero, with nutritional and exercise programs during and after pregnancy.
Put more emphasis on kids
According to the report, the incidence of overweight and obese kids since the early 1970s has approximately doubled among children ages 2 to 11 years and tripled among adolescents ages 12 to 19 years. Advice like "spend more time outside and less time in front of the TV" won't cut it in 2010. The environment at home, at school, and in the community needs a complete overhaul, the panel concludes: Get TVs out of children's bedrooms. Create safe routes for walking or biking to school. Organize recreational sports leagues that encourage kids who may not be athletically gifted to join up. Get soda and junk food out of school.
Change the environment
The report is the first to identify community barriers that get in the way of a healthy lifestyle and to offer suggestions for how to get around them. Healthy food should be cheaper and easier to find, say the advisors, especially in low-income neighborhoods. Among their solutions: open more grocery stores and promote farmers' markets. And to meet minimum weekly standards for physical activity of an hour of vigorous exercise or 2½ hours of moderate exercise, the report calls for more workplace help, perhaps by offering employees gym membership discounts and encouraging them to get up and move around during frequent breaks built into the work day.
Members of the Dietary Guidelines Advisory Committee
Linda V. Van Horn, Ph.D. RD, LD, (Chair) Professor and Interim Chair, Department of Preventative Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ill. Dr. Van Horn has expertise extending across many areas of nutrition research and public health as a nutrition epidemiologist who has conducted population level research in the prevention and treatment of cardiovascular disease, obesity, and breast cancer. She is currently the principal investigator in the Women's Health Initiative Extension Study and the Dietary Intervention Study in Children.
Naomi K. Fukagawa, M.D., Ph.D., (Vice Chair) Professor of Medicine and Associate Program Director of the Clinical Research Center, University of Vermont and Fletcher Allen Health Care, Burlington, Vt. Dr. Fukagawa is a board-certified pediatrician and an expert in nutritional biochemistry and metabolism, including protein and energy metabolism; oxidants and antioxidants; and the role of diet in aging and chronic diseases, such as diabetes mellitus. She chaired the National Institutes of Health Clinical Research Centers' Committee and is currently a member of the National Institutes of Health Integrative Physiology of Diabetes and Obesity Study Section.
Cheryl Achterberg, Ph.D., Dean and Professor, College of Education and Human Ecology, The Ohio State University, Columbus, Ohio. Dr. Achterberg's research has evaluated the impact of behavior on the dietary patterns of populations, including low-income and elderly Americans. She served on panels for numerous groups, including the World Health Organization, the Institute of Medicine, and the UN as an expert in nutrition education and community interventions.
Lawrence J. Appel, M.D., M.P.H., Professor of Medicine, Epidemiology, and International Health (Human Nutrition), Division of General Internal Medicine, and Director, ProHealth Clinical Research Unit, Johns Hopkins Medical Institutions, Baltimore, Md. Dr. Appel is a physician whose research pertains to the prevention of hypertension, cardiovascular disease, and kidney disease, typically through lifestyle modification, such as dietary intake of sodium and potassium. Dr. Appel served on the 2005 Dietary Guidelines Advisory Committee as a member of the science review subcommittee and Chair of the electrolytes subcommittee. He also served on several committees for the Institute of Medicine, including the Dietary Reference Intake Panel for electrolytes and water, which he chaired.
Roger A. Clemens, Dr.P.H., Associate Director, Regulatory Science, and Adjunct Professor, Pharmacology and Pharmaceutical Science, The University of Southern California, Los Angeles. Dr. Clemens has extensive experience in functional foods and technology with a special emphasis on probiotics and prebiotics. He has expertise in toxicology and food safety, as well as knowledge of food processing and the food industry. He is a spokesperson for the American Society for Nutrition and the Institute of Food Technologists.
Miriam E. Nelson, Ph.D., Director, John Hancock Center for Physical Activity and Nutrition, Tufts University, Boston, Mass. Dr. Nelson is a leading authority on physical activity and energy balance, with extensive research experience integrating the science of energy balance into behavior change programs. She recently served as Vice Chair of the first Physical Activity Guidelines for Americans Advisory Committee chartered by the Department of Health and Human Services.
Sharon M. Nickols-Richardson, Ph.D., R.D., Associate Professor, Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pa. Dr. Nickols-Richardson's expertise focuses on dietary and physical activity determinants of muscle strength and bone density, as well as dietary interventions for obesity and nutrition over the lifecycle from child nutrition to older adults. She served the Institute of Medicine as a consultant on the Dietary Reference Intakes book The Essential Guide to Nutrient Requirements.
Thomas A. Pearson, M.D., Ph.D., M.P.H., Senior Associate Dean, Clinical Research and Albert D. Kaiser Professor, Department of Community and Preventive Medicine, University of Rochester School of Medicine and Dentistry, Rochester, N.Y. Dr. Pearson is an epidemiologist specializing in lipid metabolism and the prevention of cardiovascular disease. He contributed significantly to the American Heart Association's guidelines for prevention of heart disease and stroke, and is a founding member of the World Heart Forum for Cardiovascular Disease Prevention.
Rafael Pérez-Escamilla, Ph.D., Professor, Nutritional Sciences and Public Health, University of Connecticut, and Director, Connecticut Center of Excellence for Eliminating Health Disparities among Latinos, Storrs, Conn. Dr. Pérez-Escamilla is an internationally recognized scholar in the area of community nutrition for his work in food safety, obesity, diabetes, and food security, with a specialty in Latinos and low-income American populations. He is currently serving the Institute of Medicine in re-examining the pregnancy weight gain guidelines.
Xavier Pi-Sunyer, M.D., M.P.H., Professor of Medicine, Columbia University College of Physicians and Surgeons and Chief, Division of Endocrinology, Diabetes, and Nutrition, St. Luke's-Roosevelt Hospital Center, New York. Dr. Pi-Sunyer has expertise in obesity, type 2-diabetes, carbohydrate and lipid metabolism, and general medicine with over 250 research papers on these topics. He chaired a National Heart Lung and Blood Institute obesity committee and served on the Institute of Medicine Dietary Reference Intake Panel on macronutrients. He also served on the FDA's Science Board Advisory Committee to the Commissioner, and as a member of the 2005 Dietary Guidelines Advisory Committee.
Eric B. Rimm, Sc.D., Associate Professor of Medicine, Harvard Medical School, and Associate Professor of Epidemiology and Nutrition, Harvard School of Public Health, Boston. Dr. Rimm is an epidemiologist whose research evaluates the impact of lifestyle factors, particularly diet, that relate to the risk for obesity, diabetes, heart disease, and stroke. He is internationally known for his work on moderate alcohol consumption and health and served on the Institute of Medicine Dietary Reference Intakes Panel for macronutrients.
Joanne L. Slavin, Ph.D., RD, Professor, Department of Food Science and Nutrition, University of Minnesota, Minneapolis. Dr. Slavin is an expert in carbohydrates and dietary fiber. Her research expertise focuses on the impact of whole grain consumption in chronic diseases, such as cancer, cardiovascular disease, and diabetes, as well as the role of dietary fiber in satiety.
Christine L. Williams, M.D., M.P.H., Vice President and Medical Director Healthy Directions, Inc., and former Professor, Clinical Pediatrics, and Director, Children's Cardiovascular Health Center, Columbia University, New York. Dr. Williams is an expert in nutrition in cancer prevention and preventive cardiology, especially hypercholesterolemia, in children. She received the prestigious Preventive Cardiology Academic Award from the National Heart Lung and Blood Institute of the National Institutes of Health for her work in preventive cardiology for children.