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

sugar-sweetened 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

Men > 45 years Women > 55 years

Moderation 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 sideFor 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