Download Living Healthy

Start Living Healthy
Seiji Yamada, MD, MPH
Nutrition and Your Health:
Dietary Guidelines for
Americans
2005 Dietary Guidelines
Advisory Committee Report
*Healthy Hawai‘i Initiative Provider Training
Nine Key Messages









Consume a variety of food
Control calorie intake to manage body weight
Be physically active every day
Fruits/vegetables/whole grains/low-fat milk
Choose fats wisely
Choose carbohydrates wisely
Cut down on salt
If you drink, use alcohol in moderation
Keep food safe to eat
1. Consume a variety of foods




within and among the basic food groups
while staying within energy needs
Promote intake of vitamin E, calcium,
magnesium, potassium, and fiber by
children and adults
Promote intake of vitamins A and C by
adults
2. Control calorie intake to
manage body weight




Calories do count - not the proportion
of carbohydrates, fat, and protein in
diet*NEJM 2003 May 22
A calorie deficit of 50 to 100 calories a
day allows weight maintenance in
adults
Monitor weight regularly
Limit portion size
3. Be physically active every
day




Moderate physical activity at least 30 mins.
every day reduces risk of obesity, HTN, DM,
CAD*Start Living Healthy message: 30 minutes, most days.
Many adults need up to 60 mins. to prevent
weight gain
60 to 90 minutes to prevent weight regain
Children and adolescents need 60 mins. on
most days
*role for pedometers?
4. Choose fats wisely



Limit animal fats & cholesterol
Limit trans fats (partially hydrogenated
vegetable oils)
Reduced risk of sudden/CHD death
associated with 2 servings of fish/week
(pregnant, lactating women, children
need to avoid mercury)
5. Choose carbohydrates
wisely



Choose whole fruits rather than juices
Choose whole grains rather than refined
grains
Reduce added sugars, especially sugarsweetened beverages
6. Fruits & vegetables, whole grains,
reduced-fat milk products

2½ to 6½ cups of fruits and vegetables
daily
*Provider Training: children 5 servings, adult women 7, adult men 9



Brown rice over white rice
Whole wheat over white bread
Adults: 3 cups skim or low-fat milk per
day (Ca, Mg, K, vit D)
7. Choose and prepare foods
with little salt



to lower blood pressure
Potassium-rich diets blunts effect of salt
Goal: < 2,300 mg sodium per day
8. If you drink alcohol, do so
in moderation

Mortality reduction primarily seen in



Moderation



Men > 45 years
Women > 55 years
Men: up to two drinks per day
Women: up to one drink per day
Beer 12 oz., wine 5 oz., spirits 1.5 oz.
9. Keep food safe to eat

Foodborne diseases yearly toll in U.S.



76 M illnesses
325,000 hospitalizations
5,000 deaths
Putting it all together

Dietary Approaches to Stop Hypertension
DASH diet (N Engl J Med. 1997 Apr 17;336(16):1117-24)





High fruits and vegetables
High in low-fat dairy
In hypertensives, reduced systolic BP by 11.4 mm
Hg and diastolic BP by 5.5 mm Hg
DASH Sodium: Low salt
+ 30 mins. physical activity
*Idaho Plate Method
Healthy meal: 9 inch plate:
 1/2 vegetables
 1/4 carbohydrates
 1/4 protein
 fruit and dairy on the side
For Type 2 DM, for low-literacy, ESL

Microeconomics



diets based on refined grains, added
sugars, and added fats are more
affordable
diets based on lean meats, fish, fresh
vegetables, and fruit are not
Drewnowski A. Obesity and the food environment. Am J Prev Med
2004;27(3S):154–162.
Control of lives is related to
control of land, systems of
productions, and the formal
political and legal structures in
which lives are embedded.
-Paul Farmer. Infections and
Inequalities.
Microconomics




Supersizing phenomenon
Main cost of fast-food industry: labor
Marginal cost of additional food
insignificant
Consumer feels he’s getting a better
deal
Economics



3,800 calories of food a day produced
for every American
500 calories more than 30 years ago
Drives agribusiness imperative to induce
consumers to eat more
The Supply Side




Meat-packing plants: Nebraska;
Greeley, Colorado
Migrant workers
Work conditions reminiscent of The
Jungle
Marshallese: agribusiness in Oklahoma,
chicken processing in Arkansas
Marketing the Product

Marketing to children



McDonald’s Playlands
A good parent gives his children what they
like
School cafeterias & vending machines
Future directions



Limits on advertising to children
Junk food, soda machines out of schools
Shift government subsidies




from sugar and grain production
to fruits and vegetables
Discounted health insurance for workplace
wellness programs
Focus on built communities