What
is the best way to interpret the 2005 Dietary Guidelines?
Historically, the US Department of Health and Human Services has
developed a set of workable nutrition guidelines that could be used
by almost everyone. The latest Dietary Guidelines for Americans,
however, reflect a strong weight-control focus. The Executive Summary
notes that that major causes of illness and death are related to
poor diet and a sedentary lifestyle. It goes on to say that poor
diet and physical inactivity are the most important contributing
factors to increasing weight in the United States. It concludes
that "Combined with physical activity, following a diet that
does not provide excess calories according to the recommendations
in this document [our emphasis] should enhance the health of
most individuals." Well, there's the rub. Because when weight
and calorie counting are major factors in our relationship with
food and activity, lots of us stop thinking about balance, moderation,
and variety - the time-tested guarantors of healthy living. Often,
there is a tendency to start thinking in black and white: physical
activity + a diet without excess calories = enhanced health for
all. One survey has reported that 70% of Americans think of food
in terms of good and bad. So the new emphasis on weight control
runs a risk of actually overshadowing the more useful suggestions
about how to create a healthful balance of nutritious foods. Of
equally great concern is the possibility that it may promote a higher
degree of conflict around eating, physical activity, and body image
for some individuals. Disordered eating and compulsive exercise
are serious issues on many college campuses, and many college-aged
women, in particular, have an inadequate intake of calcium, iron,
and other important nutrients, often as a result of trying to limit
the caloric intake of their diets.
Canada's
VITALITY campaign, designed to complement Canada's Food Guide to
Healthy Eating acknowledges the importance of healthy weight, but
also addresses problematic aspects of weight control (which the
2005 Dietary Guidelines do not). The result is a more health-based
approach:
Enjoy
eating well, being active, and feeling good about yourself: that's
VITALITY.
There
is nothing wrong with pursuing a healthy body. Indeed, people who
take control of their health tend to have a lowered risk for chronic
illnesses. The difficulty lies in the discrepancy between what weight
is considered healthy and what many Canadians see as an ideal body
weight. After decades of hearing the media and the fashion, food
and fitness industries glorify unrealistic images of feminine thinness
and male muscularity, many Canadians over-value their body weight
and size as keys to attractiveness, success, happiness and good
health. However, the number of Canadians who are overweight is increasing.
While
a reduction in weight will improve the health of some overweight
people, a fixation on weight reduction and an ideal body shape can
lead to yo-yo dieting, weight cycling, restrictive eating, obsessive
exercising and negative perceptions of body image. Furthermore,
the pursuit of a rigid standard for size and shape inevitably fails
for most people over the long term. One- to two-thirds of lost weight
is usually regained within one year and almost all is regained within
five years.
Source: Health
Canada, Office of Nutrition Policy and Health Promotion.
Interestingly, a California study compared changes in weight, labwork,
eating behavior, eating attitudes, and psychology (self-esteem,
depression, body image) between two groups of women receiving 6
months of weekly group education. The first group received behavior-based
weight loss education which included nutrition information, moderate
calorie and fat restriction, keeping a food diary, and monitoring
weight. The second group used a Health At Every Size (HAES) approach
which focused on body acceptance, decreasing restrictive eating,
increasing attendance to internal cues for hunger and satiety, nutrition
information, and addressing barriers to enjoyable physical activity.
The results
were pretty striking. At the two-year follow-up point, the HAES
group showed sustained and significant improvements in total cholesterol,
LDL, blood pressure, moderate physical activity, restricted eating,
susceptibility to hunger, body dissatisfaction, and self-esteem.
The diet group did not sustain positive changes in any of these
areas, and in fact, self-esteem was shown to be significantly worse
at the two-year follow-up point. Fifty-three per cent of the diet
participants expressed feelings of failure, compared with 0% of
the HAES group.
So in
the interests of balance and moderation (two principles of healthy
living that never go out of style), we are providing the 2005 Dietary
Guidelines for Americans AND emphasizing a personalized approach
that reinforces enjoyment and self-confidence where health decisions
are concerned.
Consume
a variety of nutrient-dense foods and beverages from among all the
basic food groups. Choose foods that
limit the intake of saturated and trans fats, cholesterol, added
sugars, salt, and alcohol.
Eating a wide variety of foods from all the food groups (grains,
fruits, vegetables, protein, dairy, and fats and oils) has always
been part of healthy eating. A helpful goal is to try for at least
3-4 different food groups at each meal. And although the "foods
to limit" are not health-enhancing when consumed in large quantities
on a frequent basis, they can still be part of a healthy diet. The
80/20 Guideline may be the best approach here: If 80% of your dietary
choices are nutrient-dense and moderate, the remaining 20% can be
otherwise - allowing you optimal variety, health, AND pleasure.
To
maintain body weight in a healthy range, balance calories from foods
and beverages with calories expended. To
prevent gradual weight gain over time, make small decreases in food
and beverage calories and increase physical activity.
Your body is not a checkbook, and weight regulation is far more
complex than a simple equation of calories in = calories out. Physical
activity does help the body to regulate healthy weight, but
the big picture may not be about calories expended vs. calories
consumed. Although physical activity burns calories and builds muscle
mass (which tends to promote higher calorie expenditure), of greater
significance may be the role of activity in 1) enhancing tissue/muscle
sensitivity to insulin, and 2) enhancing the ability of tissues
to regulate energy balance by accurately signaling hunger and fullness.
Clear, accurate hunger and fullness signals are a primary means
of self-regulating energy balance, thereby promoting a healthy body
weight at any age. Making an intellectual decision to change what
you are eating relative to your physical activity (or vice versa)
isn't necessary, and it's potentially problematic. You may come
to feel that you have to restrict your eating on days when you are
less active, or compel yourself to exercise because you've eaten
a certain type or amount of food, both of which are criteria for
eating disorders and unhealthy exercise. As shown below, there are
lots of great benefits to being active, but weight management is
the least of them - and for good reason.
Engage
in regular physical activity and reduce sedentary activities to
promote health, psychological well-being, and a healthy body weight.
Participate in 30-90 minutes of daily
moderate-intensity physical activity, including cardiovascular conditioning,
stretching exercises, and strength training to achieve physical
fitness.
There are lots of great reasons to be physically active:
Reduced
risk of chronic diseases like diabetes, hypertension, and cardiovascular
disease
Improved
duration and quality of sleep
Improved
energy levels
Improved
mood and decreased stress
Improved
body image
Improved
bone density
And
many, many more…
However,
too strong a link between weight control and physical activity is
problematic. First of all, there are some questions about the scientific
basis for some of the exercise recommendations given in the Guidelines.
Thirty minutes of physical activity per day is the well-documented
standard for reducing the risk for chronic diseases, and a body
of research has suggested that 60 or more minutes per day allowed
the study participants to stay at a body mass index between 19 and
25. But it's a pretty big leap from that finding to making the statement
that 60-90 minutes per day of physical activity is needed in order
for adults to lose weight. And when activity becomes a prescription
for weight loss, people stop thinking of movement as something that's
fun, and start thinking of it as a way to fix their body. This can
result in activity becoming joyless and driven, or guilt-ridden
and avoided, neither of which are health-enhancing outcomes. It
can also result in people walking away from physical activity when
they don't get the "ideal" body they are looking for.
So focus on fun and enjoyment when you think about being active;
concentrate on the pleasure and satisfaction you get from moving
your body to music, being in nature, participating in a team sport,
or becoming more accomplished with an active hobby. Enjoyment is
a far better predictor of consistency with physical activity than
worry or guilt, and it brings many more health benefits; the key
is the FUN factor!
Encourage
intake of fruits, vegetables, whole-grains, and low-fat dairy products.
These food groups provide many important vitamins and minerals,
as well as the complex carbohydrates so important to your brain
and muscles. Eating these foods will help lower your risk for many
diseases, including osteoporosis, high blood pressure, and some
types of cancer.
Choose
an average of two cups of fruit and 2 ½ cups of vegetables
per day. Select from dark green, orange, legume (beans, peas,
lentils), starchy, and other vegetables several times a week.
Choose
three or more servings of whole-grain products per day; aim for
at least half your daily grain intake from whole-grain choices.
Choose
3 cups per day of fat-free or low-fat milk or yogurt. People with
lactose intolerance will usually do better with yogurt, but calcium-fortified
soy milk products are also an option, particularly if someone
is vegan or otherwise dairy-avoidant.
Consume
less than 10% of total calories from saturated fats, and less than
300 mg/day of cholesterol; try to keep trans fat consumption as
low as possible. Keep total fat intake
between 20-35% of total calories, with most fats coming from polyunsaturated
and monounsaturated sources such as fish, nuts, and vegetable oils.
Choose lean, low-fat, or fat-free versions of meat, poultry, dry
beans, and milk products.
Don't interpret this as the less fat, the better -some dietary fat
is needed for good health and pleasure! Fats supply long-lasting
energy, and hence, appetite control. They help with the transport
and absorption of the fat-soluble vitamins (A, D, E, K), form the
backbone of hormones (particularly estrogen), wrap the brain and
the nerves, and are responsible for the intensity of flavor in many
foods. Here are some things to keep in mind:
Although
foods high in saturated fat (animal fat, butter, whole-milk dairy
products, coconut, palm, and palm kernel oils) can increase the
risk of cardiovascular disease when consumed frequently or in
large amounts, you can still include these foods sometimes as
part of a healthy diet. Just make sure that you are choosing polyunsaturated
and monounsaturated fats most of the time.
Trans
fats, also known as partially hydrogenated or hydrogenated fats,
are usually present in foods when polyunsaturated or monounsaturated
fats are exposed to extremely high temperatures or otherwise manipulated
in order to lengthen the shelf-life of a food product. Commercial
baked goods, stick margarines, and fast-foods tend to contain
significant amounts. These trans fats tend to have an even more
negative effect on cholesterol levels than saturated fats, but
the same guidelines of consumption apply: eaten in small amounts
or on an infrequent basis as part of an otherwise nutrient-dense
diet, these foods allow for health, variety, AND pleasure.
Balancing
higher-fat and lower-fat choices within meals keeps your dietary
intake of fat moderate. If you have chosen another source of dietary
fat for your meal, low-fat or fat-free protein/dairy choices can
be a great way to provide that balance. But it's important that
each meal contain a little bit of fat, and higher-fat versions
of these foods are a legitimate option. Sometimes you'll have
a salad with vinaigrette, and sometimes you'll have a grilled-cheese
sandwich; you need to have the option of choosing either (and
sometimes both!) in order to be a balanced, normal eater.
Choose
fiber-rich fruits, vegetables, and whole-grains often. Choose
and prepare foods and beverages with little added sugars or caloric
sweeteners. Practice good oral hygiene.
Most people like sweet-tasting foods and for good reason: we may
have been biologically programmed to gravitate towards foods that
suggested ripeness and a ready source of carbohydrate (the only
fuel for the brain). Sugar is a form of carbohydrate, and like all
carbohydrate, is converted to circulating glucose in the body after
digestion. The above guideline encourages moderate use of sugary
foods and beverages because they tend to contain very few vitamins
and minerals, and it's easy to fill up on them at the expense of
more nutrient-dense choices. Frequent consumption of sweet foods
and beverages in the absence of good dental habits may also promote
tooth decay. Used in small amounts as an addition to a meal (rather
than as a replacement), sweet foods and beverages provide a source
of carbohydrate that is very enjoyable. Sugar substitutes are an
option, but they may not save that many calories, and some research
suggests that the insulin response to artificial sweeteners may
actually increase appetite.
Choose
and prepare foods with little salt; aim for an intake of less than
2,300 mg of sodium per day (approximately 1 teaspoon). At
the same time, consume potassium-rich foods such as fruits and vegetables.
Sodium and sodium-chloride (commonly known as salt) occur naturally
in the foods that you eat, but are also found in large amounts in
processed foods that have been canned, bottled, packaged, or frozen.
Excess sodium intake is associated with high blood pressure in some
individuals, and is also thought to be a factor in calcium losses
and the risk of osteoporosis. Most people eat far more salt than
is needed. Cooking with spices and herbs instead of salt, opting
for reduced-sodium versions of sauces, condiments, soups, and packaged
foods, and not using additional salt at the table are all ways to
begin being more moderate with salt intake.
Potassium, however, which is found abundantly in fruits, vegetables,
and dairy products, has been shown to promote healthy blood
pressure, may reduce the risk of kidney-stones, and may help prevent
bone loss with age.
Those
who choose to drink alcoholic beverages should do so sensibly and
in moderation - defined as the consumption of up to one drink per
day for women and up to two drinks per day for men. Alcoholic
beverages should not be consumed by individuals who cannot restrict
their intake, women of child-bearing age who may become pregnant,
pregnant and lactating women, children and adolescents, individuals
taking medications that can interact with alcohol, individuals engaging
in activities that require attention, skill, or coordination (operating
machinery), and those with specific medical conditions.
Because alcohol contains few or no nutrients, consumption of alcohol
at the expense of food is a recipe for under-nourishment, particularly
for heavy drinkers. Drinking beyond moderate levels raises the risk
of accidents, violence, hypertension, liver disease, certain cancers,
and suicide. Alcohol may have beneficial effects when consumed in
moderation, particularly where heart disease is concerned. In college,
alcohol use dramatically increases the risk of injury, sexual assault,
unprotected sexual activity, fights and vandalism. It's important
to remember the definition of moderate drinking for this particular
dietary guideline: 1 drink a day for women, and 2 drinks a day for
men. Health benefits are lost if daily drinks are "saved up"
for the weekend. Click here
to learn more about the risks and realities of college drinking.
To
avoid foodborne illness, clean hands, food contact surfaces, and
fruits and vegetables. Separate raw,
cooked, and ready-to-eat foods while shopping, preparing or storing
foods. Cook foods to a safe temperature to kill microorganisms.
Refrigerate perishable food promptly and defrost foods properly.
Avoid raw or unpasteurized milk or any products made from unpasteurized
milk, raw or partially-cooked eggs or foods containing raw eggs,
raw or undercooked meat and poultry, unpasteurized juices, and raw
sprouts.
These guidelines are most critical for people who are particularly
vulnerable: the very young, very old, pregnant women, and individuals
with immuno-deficiency issues or certain chronic diseases. Having
said that, most people would probably choose to avoid upset stomachs,
diarrhea, fever, vomiting, abdominal cramps, dehydration, and at
the extreme - paralysis and meningitis, if they could. It's safest
to keep cold foods cold (below 40 F) and hot foods hot (above 140
F), and to use refrigerated leftovers within 3-4 days. If in doubt,
throw it out. For more on safe food preparation, go to our page
on Healthy
Eating Off Meal Plan.
How
can I make the Dietary Guidelines work for me?
In 1996 the Dietary Guidelines Alliance put together a health promotion
campaign called It's All About You. From it came messages
that were designed to help Americans feel confident and comfortable
with implementing the Guidelines in their daily lives. Even with
the most recent shift in nutrition policy, balance, moderation,
and flexibility carry the day when it comes to a healthy perspective
on food and eating, so keep the following tips in mind when interpreting
the Dietary Guidelines for yourself:
Be
realistic. Make gradual, small changes over time in what you eat
and in your level of exercise. Small steps work better than giant
leaps!
Be
adventurous. Expand your tastes to enjoy a variety of foods.
Be
flexible. Look at what you eat and the physical activity you do
over several days. There's no need to worry about what happens
at every meal.
Be
sensible. Enjoy all foods; just don't overdo it. All things in
moderation is the best approach to healthy eating.
Be
active. Taking a walk between classes, playing a game of Frisbee,
and going dancing are easy ways to get exercise.
In the
end, it isn't about being perfect with eating; it's about healthy,
normal, "good enough" eating. Ellyn Satter, RD, defines
"normal eating" this way:
Normal
eating is going to the table hungry and eating until you are satisfied.
It is being able to choose food you like and eat it and truly
get enough of it - not just stop eating because you think you
should.
Normal
eating is being able to give some thought to your food selection
so you get nutritious food, but not being so wary and restrictive
that you miss out on enjoyable food.
Normal
eating is giving yourself permission to eat sometimes because
you are happy, sad or bored, or just because it feels good. Normal
eating is three meals a day, or four or five, or it can be choosing
to munch along the way.
It
is leaving some cookies on the plate because you know you can
have some again tomorrow, or it is eating more now because they
taste so wonderful.
Normal
eating is overeating at times and wishing you had more. Normal
eating is trusting your body to make up for your mistakes in eating.
Normal eating takes up some of your time and attention, but keeps
its place as only one important area of your life.
In
short, normal eating is flexible. It varies in response to your
hunger, your schedule, your proximity to food and your feelings.
You can see more details about each of the Dietary Guidelines at
the web site put out by the US Departments of Health and Human Services
and Agriculture. Detailed support statements are given for each
guideline. Additional information is listed for several government
and non-government resources.
This Health Canada page from the Office of Health Promotion provides
the health statistics and theoretical background for the VITALITY
campaign.
This Nutrition page on the Health Education website covers topics
on healthy weight, body mass index, dieting, listening to hunger
and fullness, and emotional eating.
Daily Tips and Feature Topics often have articles of interest. By
sending an email,
you can ask questions directly of registered dietitians in your
area. Nutrition Network is a national referral service for registered
dietitians in their areas nutrition. Award-winning web site.
How to Fuel It and Move It for a Fun and Healthy Life. A PDF brochure
based upon the It's All About You campaign. Lots of practical,
low-stress ideas for making changes with healthy eating and physical
activity.
The Nutrition section of WebMD includes a food and nutrition newsletter,
a diet and fitness organizer and healthy recipes.
This reliable source on vegetarian diets was given the top rating
by the Tufts University Nutrition Navigator, a nutrition web site
rating guide. Recipes, games and information on nutrients such as
protein, calcium and iron included.
Disclaimer: Health Education is part of Health Services at Brown University. Health Education maintains this site as a resource for Brown students. This site is not intended to replace consultation with your medical providers. No site can replace real conversation. Health Education offers no endorsement of and assumes no liability for the currency, accuracy, or availability of the information on the sites we link to or the care provided by the resources listed. Health Services staff are available to treat and give medical advice to Brown University students only. If you are not a Brown student, but are in need of medical assistance please call your own health care provider or in case of an emergency, dial 911. Please contact us if you have comments, questions or suggestions.
