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A conceptual framework for developing a dietary guidance system
A Conceptual Framework for Developing a Dietary Guidance System ARDYTH
H.
GILLESPIE
Division of Nutritional Sciences, Cornell University, Ithaca, New York 14853
ABSTRACT Dietary guidance is central to nutrition education efforts. Yet little attention has been focused on the process of developing dietary guidance aids. This paper suggests a conceptual model for developing a dietary guidance system that is designed according to the user's needs and as part of a total communication program. The model links development to implementation of a system and is considered as part of a total communication program. UNE 17:139-42, 1985)
Translating current scientific nutrition knowledge into day-to-day food selection is a cornerstone of nutrition education programs. Such translation is a difficult process and has been the focus of much discussion and controversy among nutritionists. Food guides, des pite their shortcomings, have been and continue to be central to this translation process. Although possible changes in food guides have been discussed extensively (1-5), much of the discussion has focused on the use of guides and not on a process for developing them. The purpose of this paper is to present a heuristic model for translating current nutrition recommendations into practical guides for eating. The model, which is a way of conceptualizing the issues related to dietary guidance, serves as an organizing framework for research on dietary guidance. The long-term goal for su ch research is to develop a system that can facilitate the translation of scientific knowledge of food and nutrient needs into specific dietary advice for consumers and that can provide consumers with a tool for making wise food choices. Thus, a dietary guidance system is a broader concept than a food guide. In fact such a communications system represents a new generation of food guides with dynamic and multifaceted characteristics-something quite different from a one-page pictorial food guide. On the conceptual model presented here, the dietary guidance system is part of a total communication program. Consequently, the development of such a system is linked to its implementation or use. The system is dynamic, and it should evolve and improve in response to results from implementation and research. This article begins with a review of the traditional considerations in the development of a food guide and VOLUME
17
NUMBER
4
1985
then shows how to conceptualize dietary guidance as a total communication process that links the development of a dietary guidance system to its implementation. TRADITIONAL CONSIDERATIONS Historically, there have been two key considerations in the development of food guides: 1) current knowledge of nutritional needs and 2) food constraints, which include availability (the acceptability and cost of food, and its presence in the marketplace or home production system) and the nutrient composition of food. These are the basic elements in achieving the purpose of a guide, i.e., to link nutritional needs to foods we eat. In addition, developers have considered current consumption patterns and the nutritional status of the population (6). (For a more detailed review of the historical de velo pme nt of food guides, see [5].)
.. Z
Nutritional Needs • Adequacy • Excesses
YI
1
A-
...o YI
> YI
Food Constraints • Food availability • Nutrient composition of foods
/
~
o
,;:/
""
..
j:
-'
-'
Nutrition Communicator Inputs
oC Z YI
1YI
I+---
SYSTEM
,lOI
z o
Audience Status
DIETARY GUIDANCE
-------------+
", , , ,
A-
I
,,
,,
+----------- ------
1 Audience Inputs
t
~
...
,,
• Consumption patterns • Nutritional status
Intervening Process
im __ n___ n_m __ n1
L
Outcomes
I-n---mnn existing influences ----- suggested influences
Framework for Developing and Implementing a Dietary Guidance System
Figure 1.
JOURNAL OF NUTRITION EDUCATION
139
Published examples (1-4,6) illustrate how a variety of guides can be created from these components. However, many experts think a new approach is needed (e.g., 5,7,8). Still, there seems to be little consensus about or consistency in the criteria used (5). Viewing the guide as a form of communication can suggest a framework for developing such criteria. DIETARY GUIDANCE AS A COMMUNICATION STRA TEGY If we consider the translation of scientific knowledge into dietary recommendations as a communication process (9), a dietary guidance system is an element in the total communication strategy (see Figure 1). Although the traditional components-nutritional needs, food constraints, consumption patterns, and nutritional status-are still important in developing an effective dietary guidance system, the characteristics of the communication process are equally important. And nutrition considerations are linked to communication strategy decisions. , The communication process, which is described in more detail elsewhere (9), consists of inputs, intervening process, and outcomes (see lower ha If of figure). The out cornes depend on the intervening process, which in turn is influenced by the inputs. Both communicators and audience members bring their own inputs to the communication process. Members of the target audience approach and respond to a dietary guidance message with a set of predispositions drawn from past experiences. These experiences have shaped their beliefs about food and nutrition, their attitudes toward eating certain foods, and their current eating practices. Members of the audience may also have beliefs and attitudes about nutritionists and other conveyors of nutrition information. Thus, nutrition information from these sources may elicit established patterns ofresponse. Therefore, in developing a dietary guidance system, it is important that communicators consider how audience members make decisions about food and what their perceptions are. Sensitivity to audience predispositions enhances a dietary guidance system's likelihood of success. The diversity of possible "audience inputs" suggests that a dietary guidance system may vary, depending on the particular target audience. Nutrition communicators make decisions about the content and treatment of dietary guidance messages and about the channels through which the messages are conveyed. To determine the content of the message, nutrition educators must resolve sorne issues about nutrition recommendations. These decisions, which relate to the "nutritional needs" component (see figure), must be made in conjunction with nutrition scientists. 140
JOURNAL OF NUTRITION EDUCATION
Communicator's also control other aspects of the strategy, such as the apparent source of information and communication system design. The input, or decisions that nutritionists make regarding the communication strategy, will influence both the intervening process and, indirectly, the outcome (as indicated by the arrows in the figure). The intervening process deals with the receivers' attention to and comprehension of the message and their interaction with others regarding the message. Audience attention and comprehension are essential to the communication strategy's success. The target audience must be aware of the message (based on the guidance system) and must decide to attend to (read, listen to) it. Then the audience must be able to understand the message that the educator is trying to convey. Talking to others about a nutrition message can enhance or hinder both comprehension of and receptivity to the message. In nutrition education, this interaction is not necessarily limited to the audience; it can include interacting with the communicator or other professionals. The intervening process is influenced not only by the nutritionist's and audience's inputs, but also by other messages in the communication environment. The environment in which the communication takes place contains thousands of messages related to nutrition and food. Messages from the mass media and interpersonal messages from conversations with friends, relatives, and associa tes may either complement or contradict the dietary guidance message. Regardless of the intent or content of these messages, they are likely to influence both the intervening process and the outcome. The outcome is the audience members' acceptance or rejection of the dietary recommendations. This may occur at three different levels: cognitive, affective, and behavioral. Specifying the objectives in terms of these levels is the first step in planning a communication strategy. (See [9] for a more detailed discussion of the communication model, its theoretical underpinning, and its applications.) Existing influences (represented in the figure by solid lines) are present whether or not we consider them. Other suggested influences (represented in the figure by broken lines) can have a positive effect if communicators take these influences into account.
THE DEVELOPMENTIMPLEMENTATION LINKAGE The most effective dietary guidance system enhances the communication process about food selection. Therefore, it is important to link the development of the system to its implementation, that is, to consider the system as part of a total communication program (as illustrated in the figure). A better understanding of the audience-their VOLUME
17
NUMBER
4
1985
decisions about food, their perceptions, and their use of current food guides-will enhance our ability to consider audience inputs wh en we design nutrition communications. Audience status-consumption patterns and nutritional status-is one of these audience inputs (see figure). We also should consider what concepts the audience members need to make wise food selections and then determine which of these concepts they already understand and which they must learn. What are the factors that influence food decisions? Have consumer surveys covered aIl the relevant factors? Sorne of our current research suggests not (Note 1). The dietary guidance system or guide to foods becomes a central input from the nutrition communicator. In turn, decisions about the message content are intimately related to the dietary guidance system. Thus, two major steps in this communication framework link the audience's inputs and the nutrition communicator's inputs directly to the development of the dietary guidance system. Once a system is in place, it is important to feed the out cornes of the communication process back into the system so that it can evolve and bec orne self-correcting. The inputs may also change and can alter dietary guidance systems as weIl. The model presented here addresses many issues that have been considered by others. Its primary contribution is to organize these various elements into a conceptual framework that allows systematic study of them. In addition, the communications framework links development to implementation and allows for a dynamic system that grows and changes as research advances our knowledge base. The model itself must be further refined through additional research. The model suggests three major research tasks: 1) to define objectives or desired outcomes of a system, 2) to determine the intervening process needed to achieve these outcomes, and 3) to assess audience inputs. Accomplishment of these tasks will pro vide a basis for developing an appropriate dietary guidance system. As an example of how the first task may be approached, the final section of this article addresses issues related to defining desired outcomes.
relative importance. A guide can be used to select diets, evaluate diets, and to serve as an educational too1. There are many possible educational objectives of a guide. For example, a guide can be used to convey the meaning of an adequate diet, of nutrient needs or requirements, of nutrient composition of foods, and of current diet-health issues. Another issue that has been addressed in professional discussions of dietary guidance is whether the focus should be on foods or nutrients (10,11, Note 2). A related issue is whether a guide should represent a foundation diet or a total diet. The foundation diet, which suggests certain foods or groups of foods as minimum recommendations with additional foods (kilocalories) added as needed, has been the traditional approach (5). Another approach is to pro vide guidance that includes the total diet. This approach allows consideration of both excessive and sufficient amounts of nutrients and other dietary components. For an example of this approach, see Gillespie and Roderuck (12). Ideal versus practical considerations also come into play when professionals seek to determine the best possible dietary guidance system. On the one hand, a system can reflect dietary advice based on the best possible diet according to the current state of nutrition research (13). On the other hand, a guidance system that differs too much from the current U.S. diet may not be acceptable to consumers (14). Given the increased concern about excess consumption and the recent guidelines that address this matter (13,15,16), overconsumption is an important issue for a dietary guidance system to address. These key issues serve to illustrate sorne of the concerns that professionals interested in dietary guidance need to address to develop specific objectives for a dietary guidance system. Such matters should be considered within the context of other issues such as the guide's precision, accuracy, and usability, as discussed by Light and Cronin (5). The conceptual framework presented here suggests that the views of nutritionists and potential audience members should be considered. 0 ACKNOWLEDGMENTS
DEFINING DESIRED OUTCOMES OF A DIET ARY GUIDANCE SYSTEM According to Light and Cronin, "the historical objective of food guides developed by the U.S. Department of Agriculture (USDA) has been to translate dietary standards and recommendations into simple and reliable nutrition education tools useful to consumers in improving the nutritive balance of dietary patterns" (5). Most nutritionists are likely to agree on this general objective. However, it may be more difficult to reach a consensus on more specific desired out cornes and their
VOLUME
17
NUMBER
4
1985
Through discussions with the author, rnany colleagues and students have contributed to the ideas presented here. 1 wou Id especially like to acknowledge Dr. Marjorie M. Devine, Dr. Carole A. Bisogni, Professor Ruth N. Klippstein, and Cheryl Achterberg, aIl of Cornell University.
NOTES C. Sorne factors that affect working rnothers' food choices. M.S. Thesis, Cornell University, Ithaca, NY, 1982, pp. 51-94. 2 National Dairy Council. Annual nutrition research conference: Translating nutrition recornrnendations into food selection. Atlanta, Georgia, April 12, 1981. 1 Kirk, M.
JOURNAL OF NUTRITION EDUCATION
141
LITERATURE CITED 1 Guthrie, H. S., and J. C. Scheer. Nutritional adequacy of self selected diets that satisfy the Four Food Groups guide. Journal of Nutrition Education 13:46-49, 1981. 2 Dodds, J. M. The handy five food guide. Journal of Nutrition Education 13:50-52, 1981. 3 Pennington, J. A. T. Considerations for a new food guide. Journal of Nutrition Education 13:53-55, 1981. 4 Lachance, P. A. A suggestion on food guides and dietary guidelines. Journal of Nutrition Education 13:56, 1981. 5 Light, L., and F. J. Cronin. Food guidance revisited. Journal of Nutrition Education 13:57-62, 1981. 6 Page, L., and E. F. Phipard. Essentials of an adequate diet: Facts for nutrition programs. V.S. Department of Agriculture, Home Economics Research Report No. 3, 1957,21 pp. 7 Hegsted, D. M. What is a healthful diet? Primary Care 9:445-73, 1982. 8 Comptroller General of the U.S., Recommended Dietary Allowances: More better food guides needed. Washington, DC: General Accounting Office, November 30, 1976, 81 pp. 9 Gillespie, A. H., and P. Yarbrough. A conceptual model for communicating nutrition. Journal of Nutrition Education 16:168-72, 1984.
10 Hill, M., and L. Cleveland. Food guides-their development and use. Nutrition Program News, July-October, 1970, 5 pp. 11 Hicks, B. M. Food groups-Where do they belong? Food and Nutrition News 28(3):1, 4, 1977. 12 Gillespie, A. H., ~nd C. E. Roderuck. Evaluation of a nutrient guide as an educational tool. Journal of the American Dietetic Association 83:55-58, 1983. 13 Select Committee on Nutrition and Human Needs, u.s. Senate: Dietary Goals for the United States. 2d ed., Washington, DC: U.S. Government Printing Office, 1977, 83 pp. 14 Peterkin, B. B., R. K. Kerr, and C. J. Shore. Diets that meet the dietary goals. Journal of Nutrition Education 10:15-18, 1978. 15 V.S. Department of Agriculture. U.S. Department of Health and Human Services. Nutrition and yOUf health: Dietary Guidelines for Americans. Home and Garden Bulletin No. 232. Washington, DC: V.S. Government Printing Office, 1980,20 pp. 16 McNutt, K. Dietary advice to the public: 1957 to 1980. Nutrition Reviews 38:353-60, 1980.
LONG-TERM FOLLOW-UP OF CHILDHOOD OBESITY The extent ta which obesity du ring infancy and childhood predicts obesity in adulthood is of clinical importance. If a fat baby becomes a fat adult, the need for early intervention would be confirmed. According to Garn and LaVelle (American Journal of Diseoses of Chüdren 139:181-85, 1985), many long-term obesity studies contain methodological problems, including selection of subjects, definition and measurement of obesity, and presentation of results. Thus, Garn and LaVelle undertook a two-decade follow-up of early-childhood fatness. The 383 participants were drawn from a community sample, and were 0.5 to 5.5 years of age at their first examination in 1959-60. During the first examination and in three subsequent examinations (the last of which took place in 1979-80), the researchers measured subscapular and triceps skinfolds. They examined the correlation between initial skinfold measurements and subsequent ones. They also determined the percentage of children that remained in the initial fatness categories at the end of the study; change in the distribution of children within each fatness category; and the change in fatness, during two decades, of children who were lean, medium, or obese at the time of entry into the study. In addition, the investigators examined ancillary data on siblings, parents, and grandparents. The correlations of initial and subsequent skinfold measurements for both boys and girls tended to be low, but generally positive. Twenty-six percent of initially obese preschool children were still obese two decades later compared ta 15% that would be expected by chance; thus, obese children had a 1.77 risk ratio of still being obese two decades later. However, given that 74% of obese preschoolers will no longer be classified as obese when they reach adulthood, Garn and LaVelle raised the question of whether practitioners should attempt intervention. They suggested that in making the decision whether to intervene. practitioners take into account the family context. Their research revealed that the greater the number of obese persons in the immediate family, including grandparents, the greater the likelihood that the obese child will remain obese. They speculated that the obese child in a nonobese family may not warrant intervention.
ERRATUM In the article entitled: Of Flies and Honey and Vinegar (McNutt and Sloan, Vol. 17, No. 3, pp. 105-107), two lines which appear at the top of the inside column on page 106 were misplaced. These lines belong below in the paragraph which reads as follows: When journalists must choose between technical accuracy and practical utility, it is better to sacrifice sorne scientific intricacy ta make the information useful ta the Jay audience. Furthermore, it is far better for journalists ta use the language that is spoken by their audience, than to relentlessly conform to scientific definitions. The journal apologizes to readers for any confusion caused by this error.
142
JOURNAL OF NUTRITION EDUCATION
VOLUME
17
NUMBER
4
1985
H.
GILLESPIE
Division of Nutritional Sciences, Cornell University, Ithaca, New York 14853
ABSTRACT Dietary guidance is central to nutrition education efforts. Yet little attention has been focused on the process of developing dietary guidance aids. This paper suggests a conceptual model for developing a dietary guidance system that is designed according to the user's needs and as part of a total communication program. The model links development to implementation of a system and is considered as part of a total communication program. UNE 17:139-42, 1985)
Translating current scientific nutrition knowledge into day-to-day food selection is a cornerstone of nutrition education programs. Such translation is a difficult process and has been the focus of much discussion and controversy among nutritionists. Food guides, des pite their shortcomings, have been and continue to be central to this translation process. Although possible changes in food guides have been discussed extensively (1-5), much of the discussion has focused on the use of guides and not on a process for developing them. The purpose of this paper is to present a heuristic model for translating current nutrition recommendations into practical guides for eating. The model, which is a way of conceptualizing the issues related to dietary guidance, serves as an organizing framework for research on dietary guidance. The long-term goal for su ch research is to develop a system that can facilitate the translation of scientific knowledge of food and nutrient needs into specific dietary advice for consumers and that can provide consumers with a tool for making wise food choices. Thus, a dietary guidance system is a broader concept than a food guide. In fact such a communications system represents a new generation of food guides with dynamic and multifaceted characteristics-something quite different from a one-page pictorial food guide. On the conceptual model presented here, the dietary guidance system is part of a total communication program. Consequently, the development of such a system is linked to its implementation or use. The system is dynamic, and it should evolve and improve in response to results from implementation and research. This article begins with a review of the traditional considerations in the development of a food guide and VOLUME
17
NUMBER
4
1985
then shows how to conceptualize dietary guidance as a total communication process that links the development of a dietary guidance system to its implementation. TRADITIONAL CONSIDERATIONS Historically, there have been two key considerations in the development of food guides: 1) current knowledge of nutritional needs and 2) food constraints, which include availability (the acceptability and cost of food, and its presence in the marketplace or home production system) and the nutrient composition of food. These are the basic elements in achieving the purpose of a guide, i.e., to link nutritional needs to foods we eat. In addition, developers have considered current consumption patterns and the nutritional status of the population (6). (For a more detailed review of the historical de velo pme nt of food guides, see [5].)
.. Z
Nutritional Needs • Adequacy • Excesses
YI
1
A-
...o YI
> YI
Food Constraints • Food availability • Nutrient composition of foods
/
~
o
,;:/
""
..
j:
-'
-'
Nutrition Communicator Inputs
oC Z YI
1YI
I+---
SYSTEM
,lOI
z o
Audience Status
DIETARY GUIDANCE
-------------+
", , , ,
A-
I
,,
,,
+----------- ------
1 Audience Inputs
t
~
...
,,
• Consumption patterns • Nutritional status
Intervening Process
im __ n___ n_m __ n1
L
Outcomes
I-n---mnn existing influences ----- suggested influences
Framework for Developing and Implementing a Dietary Guidance System
Figure 1.
JOURNAL OF NUTRITION EDUCATION
139
Published examples (1-4,6) illustrate how a variety of guides can be created from these components. However, many experts think a new approach is needed (e.g., 5,7,8). Still, there seems to be little consensus about or consistency in the criteria used (5). Viewing the guide as a form of communication can suggest a framework for developing such criteria. DIETARY GUIDANCE AS A COMMUNICATION STRA TEGY If we consider the translation of scientific knowledge into dietary recommendations as a communication process (9), a dietary guidance system is an element in the total communication strategy (see Figure 1). Although the traditional components-nutritional needs, food constraints, consumption patterns, and nutritional status-are still important in developing an effective dietary guidance system, the characteristics of the communication process are equally important. And nutrition considerations are linked to communication strategy decisions. , The communication process, which is described in more detail elsewhere (9), consists of inputs, intervening process, and outcomes (see lower ha If of figure). The out cornes depend on the intervening process, which in turn is influenced by the inputs. Both communicators and audience members bring their own inputs to the communication process. Members of the target audience approach and respond to a dietary guidance message with a set of predispositions drawn from past experiences. These experiences have shaped their beliefs about food and nutrition, their attitudes toward eating certain foods, and their current eating practices. Members of the audience may also have beliefs and attitudes about nutritionists and other conveyors of nutrition information. Thus, nutrition information from these sources may elicit established patterns ofresponse. Therefore, in developing a dietary guidance system, it is important that communicators consider how audience members make decisions about food and what their perceptions are. Sensitivity to audience predispositions enhances a dietary guidance system's likelihood of success. The diversity of possible "audience inputs" suggests that a dietary guidance system may vary, depending on the particular target audience. Nutrition communicators make decisions about the content and treatment of dietary guidance messages and about the channels through which the messages are conveyed. To determine the content of the message, nutrition educators must resolve sorne issues about nutrition recommendations. These decisions, which relate to the "nutritional needs" component (see figure), must be made in conjunction with nutrition scientists. 140
JOURNAL OF NUTRITION EDUCATION
Communicator's also control other aspects of the strategy, such as the apparent source of information and communication system design. The input, or decisions that nutritionists make regarding the communication strategy, will influence both the intervening process and, indirectly, the outcome (as indicated by the arrows in the figure). The intervening process deals with the receivers' attention to and comprehension of the message and their interaction with others regarding the message. Audience attention and comprehension are essential to the communication strategy's success. The target audience must be aware of the message (based on the guidance system) and must decide to attend to (read, listen to) it. Then the audience must be able to understand the message that the educator is trying to convey. Talking to others about a nutrition message can enhance or hinder both comprehension of and receptivity to the message. In nutrition education, this interaction is not necessarily limited to the audience; it can include interacting with the communicator or other professionals. The intervening process is influenced not only by the nutritionist's and audience's inputs, but also by other messages in the communication environment. The environment in which the communication takes place contains thousands of messages related to nutrition and food. Messages from the mass media and interpersonal messages from conversations with friends, relatives, and associa tes may either complement or contradict the dietary guidance message. Regardless of the intent or content of these messages, they are likely to influence both the intervening process and the outcome. The outcome is the audience members' acceptance or rejection of the dietary recommendations. This may occur at three different levels: cognitive, affective, and behavioral. Specifying the objectives in terms of these levels is the first step in planning a communication strategy. (See [9] for a more detailed discussion of the communication model, its theoretical underpinning, and its applications.) Existing influences (represented in the figure by solid lines) are present whether or not we consider them. Other suggested influences (represented in the figure by broken lines) can have a positive effect if communicators take these influences into account.
THE DEVELOPMENTIMPLEMENTATION LINKAGE The most effective dietary guidance system enhances the communication process about food selection. Therefore, it is important to link the development of the system to its implementation, that is, to consider the system as part of a total communication program (as illustrated in the figure). A better understanding of the audience-their VOLUME
17
NUMBER
4
1985
decisions about food, their perceptions, and their use of current food guides-will enhance our ability to consider audience inputs wh en we design nutrition communications. Audience status-consumption patterns and nutritional status-is one of these audience inputs (see figure). We also should consider what concepts the audience members need to make wise food selections and then determine which of these concepts they already understand and which they must learn. What are the factors that influence food decisions? Have consumer surveys covered aIl the relevant factors? Sorne of our current research suggests not (Note 1). The dietary guidance system or guide to foods becomes a central input from the nutrition communicator. In turn, decisions about the message content are intimately related to the dietary guidance system. Thus, two major steps in this communication framework link the audience's inputs and the nutrition communicator's inputs directly to the development of the dietary guidance system. Once a system is in place, it is important to feed the out cornes of the communication process back into the system so that it can evolve and bec orne self-correcting. The inputs may also change and can alter dietary guidance systems as weIl. The model presented here addresses many issues that have been considered by others. Its primary contribution is to organize these various elements into a conceptual framework that allows systematic study of them. In addition, the communications framework links development to implementation and allows for a dynamic system that grows and changes as research advances our knowledge base. The model itself must be further refined through additional research. The model suggests three major research tasks: 1) to define objectives or desired outcomes of a system, 2) to determine the intervening process needed to achieve these outcomes, and 3) to assess audience inputs. Accomplishment of these tasks will pro vide a basis for developing an appropriate dietary guidance system. As an example of how the first task may be approached, the final section of this article addresses issues related to defining desired outcomes.
relative importance. A guide can be used to select diets, evaluate diets, and to serve as an educational too1. There are many possible educational objectives of a guide. For example, a guide can be used to convey the meaning of an adequate diet, of nutrient needs or requirements, of nutrient composition of foods, and of current diet-health issues. Another issue that has been addressed in professional discussions of dietary guidance is whether the focus should be on foods or nutrients (10,11, Note 2). A related issue is whether a guide should represent a foundation diet or a total diet. The foundation diet, which suggests certain foods or groups of foods as minimum recommendations with additional foods (kilocalories) added as needed, has been the traditional approach (5). Another approach is to pro vide guidance that includes the total diet. This approach allows consideration of both excessive and sufficient amounts of nutrients and other dietary components. For an example of this approach, see Gillespie and Roderuck (12). Ideal versus practical considerations also come into play when professionals seek to determine the best possible dietary guidance system. On the one hand, a system can reflect dietary advice based on the best possible diet according to the current state of nutrition research (13). On the other hand, a guidance system that differs too much from the current U.S. diet may not be acceptable to consumers (14). Given the increased concern about excess consumption and the recent guidelines that address this matter (13,15,16), overconsumption is an important issue for a dietary guidance system to address. These key issues serve to illustrate sorne of the concerns that professionals interested in dietary guidance need to address to develop specific objectives for a dietary guidance system. Such matters should be considered within the context of other issues such as the guide's precision, accuracy, and usability, as discussed by Light and Cronin (5). The conceptual framework presented here suggests that the views of nutritionists and potential audience members should be considered. 0 ACKNOWLEDGMENTS
DEFINING DESIRED OUTCOMES OF A DIET ARY GUIDANCE SYSTEM According to Light and Cronin, "the historical objective of food guides developed by the U.S. Department of Agriculture (USDA) has been to translate dietary standards and recommendations into simple and reliable nutrition education tools useful to consumers in improving the nutritive balance of dietary patterns" (5). Most nutritionists are likely to agree on this general objective. However, it may be more difficult to reach a consensus on more specific desired out cornes and their
VOLUME
17
NUMBER
4
1985
Through discussions with the author, rnany colleagues and students have contributed to the ideas presented here. 1 wou Id especially like to acknowledge Dr. Marjorie M. Devine, Dr. Carole A. Bisogni, Professor Ruth N. Klippstein, and Cheryl Achterberg, aIl of Cornell University.
NOTES C. Sorne factors that affect working rnothers' food choices. M.S. Thesis, Cornell University, Ithaca, NY, 1982, pp. 51-94. 2 National Dairy Council. Annual nutrition research conference: Translating nutrition recornrnendations into food selection. Atlanta, Georgia, April 12, 1981. 1 Kirk, M.
JOURNAL OF NUTRITION EDUCATION
141
LITERATURE CITED 1 Guthrie, H. S., and J. C. Scheer. Nutritional adequacy of self selected diets that satisfy the Four Food Groups guide. Journal of Nutrition Education 13:46-49, 1981. 2 Dodds, J. M. The handy five food guide. Journal of Nutrition Education 13:50-52, 1981. 3 Pennington, J. A. T. Considerations for a new food guide. Journal of Nutrition Education 13:53-55, 1981. 4 Lachance, P. A. A suggestion on food guides and dietary guidelines. Journal of Nutrition Education 13:56, 1981. 5 Light, L., and F. J. Cronin. Food guidance revisited. Journal of Nutrition Education 13:57-62, 1981. 6 Page, L., and E. F. Phipard. Essentials of an adequate diet: Facts for nutrition programs. V.S. Department of Agriculture, Home Economics Research Report No. 3, 1957,21 pp. 7 Hegsted, D. M. What is a healthful diet? Primary Care 9:445-73, 1982. 8 Comptroller General of the U.S., Recommended Dietary Allowances: More better food guides needed. Washington, DC: General Accounting Office, November 30, 1976, 81 pp. 9 Gillespie, A. H., and P. Yarbrough. A conceptual model for communicating nutrition. Journal of Nutrition Education 16:168-72, 1984.
10 Hill, M., and L. Cleveland. Food guides-their development and use. Nutrition Program News, July-October, 1970, 5 pp. 11 Hicks, B. M. Food groups-Where do they belong? Food and Nutrition News 28(3):1, 4, 1977. 12 Gillespie, A. H., ~nd C. E. Roderuck. Evaluation of a nutrient guide as an educational tool. Journal of the American Dietetic Association 83:55-58, 1983. 13 Select Committee on Nutrition and Human Needs, u.s. Senate: Dietary Goals for the United States. 2d ed., Washington, DC: U.S. Government Printing Office, 1977, 83 pp. 14 Peterkin, B. B., R. K. Kerr, and C. J. Shore. Diets that meet the dietary goals. Journal of Nutrition Education 10:15-18, 1978. 15 V.S. Department of Agriculture. U.S. Department of Health and Human Services. Nutrition and yOUf health: Dietary Guidelines for Americans. Home and Garden Bulletin No. 232. Washington, DC: V.S. Government Printing Office, 1980,20 pp. 16 McNutt, K. Dietary advice to the public: 1957 to 1980. Nutrition Reviews 38:353-60, 1980.
LONG-TERM FOLLOW-UP OF CHILDHOOD OBESITY The extent ta which obesity du ring infancy and childhood predicts obesity in adulthood is of clinical importance. If a fat baby becomes a fat adult, the need for early intervention would be confirmed. According to Garn and LaVelle (American Journal of Diseoses of Chüdren 139:181-85, 1985), many long-term obesity studies contain methodological problems, including selection of subjects, definition and measurement of obesity, and presentation of results. Thus, Garn and LaVelle undertook a two-decade follow-up of early-childhood fatness. The 383 participants were drawn from a community sample, and were 0.5 to 5.5 years of age at their first examination in 1959-60. During the first examination and in three subsequent examinations (the last of which took place in 1979-80), the researchers measured subscapular and triceps skinfolds. They examined the correlation between initial skinfold measurements and subsequent ones. They also determined the percentage of children that remained in the initial fatness categories at the end of the study; change in the distribution of children within each fatness category; and the change in fatness, during two decades, of children who were lean, medium, or obese at the time of entry into the study. In addition, the investigators examined ancillary data on siblings, parents, and grandparents. The correlations of initial and subsequent skinfold measurements for both boys and girls tended to be low, but generally positive. Twenty-six percent of initially obese preschool children were still obese two decades later compared ta 15% that would be expected by chance; thus, obese children had a 1.77 risk ratio of still being obese two decades later. However, given that 74% of obese preschoolers will no longer be classified as obese when they reach adulthood, Garn and LaVelle raised the question of whether practitioners should attempt intervention. They suggested that in making the decision whether to intervene. practitioners take into account the family context. Their research revealed that the greater the number of obese persons in the immediate family, including grandparents, the greater the likelihood that the obese child will remain obese. They speculated that the obese child in a nonobese family may not warrant intervention.
ERRATUM In the article entitled: Of Flies and Honey and Vinegar (McNutt and Sloan, Vol. 17, No. 3, pp. 105-107), two lines which appear at the top of the inside column on page 106 were misplaced. These lines belong below in the paragraph which reads as follows: When journalists must choose between technical accuracy and practical utility, it is better to sacrifice sorne scientific intricacy ta make the information useful ta the Jay audience. Furthermore, it is far better for journalists ta use the language that is spoken by their audience, than to relentlessly conform to scientific definitions. The journal apologizes to readers for any confusion caused by this error.
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JOURNAL OF NUTRITION EDUCATION
VOLUME
17
NUMBER
4
1985