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Can we change diet to improve health?
ENTR S OUTLOOK
Can we change diet to improve health? The high-vitamin, low-fat challenge Today, the link between diet and health is clearly established. We know that healthful eating and proper nutrition play a critical role in preventing many chronic diseases. Vitamin A is just one nutrient for which researchers are elucidating possible beneficial effects. Some data suggest that beta carotene and the antioxidants may be important anticancer agents (p 1285). As the scientific evidence comes in, the trick will be how to convince people to change habits, to put into practice what is shown to be beneficial. In February 1991 (p 162), the Journalpublished an interview in which Dean Ornish, MD, described his success at reversing coronary atherosclerosis through the use of diet (a plant-rich diet with less than 10% of energy from fat), stress management, and exercise. Ornish's program has since been endorsed by a major health insurer. Recommended diet and lifestyle changes such as these open the door for increased dietitian involvement in patient guidance. Ornish's new book, Eat More, Weigh Less, applies the same principles to weight loss. The plan, which suggests a total change in eating habits, emphasizes complex carbohydrates, and promotes consumption of beans and legumes, fruits, grains, and vegetables and only moderate amounts of low-fat commercially prepared products and low-fat dairy products. Weight loss accompanies adherence to the low-sugar, lowfat diet, which is naturally low in calories. At least two thirds of the book is devoted to recipes. Those I tried were quite flavorful, yet very low in fat and calories. Many Americans are moving to low-fat animal products or vegetarian diets. ADA's revised position on vegetarian diets (p 1317) notes that they "are healthful and nutritionally adequate when appropriately planned," and provides planning guidelines. Do Americans practice what they believe? The November Glamour features results of a healthy eating survey, which was prepared with ADA's help and completed by more than 17,000 women. Findings show that women are looking at food in a new way. Crash dieting is out; 78% exercise to lose weight. Low-fat eating is in vogue; 64% limit their fat intake. Most take time to read food labels. On the down side, eating disorders were common, and fewer than 10% ate the recommended "five-a-day" servings of fruits and vegetables. Thus, the RD's expertise and sound advice are needed now more than ever to help people implement the change to healthful eating. Connecting attitude and behavior Changing behavior is one of the dietitian's key responsibilities. However, first it is essential for researchers to understand what attitudes contribute to behavior. Robinson and coworkers (p 1311) identified the attitudes of teenage mothers toward breast-feeding in an effort to help teens recognize its advantages. Bowen et al (p 1309) looked at how current eating patterns contribute to a successful change to a low-fat diet. Dietitians employed in foodservice settings realize the importance of looking at their operation through their customers' eyes. Ouellet and Norback present a model for selecting quality standards through identifying those elements that make customers satisfied (p 1296). New data, new interpretations As health professionals we must always be willing to reexamine current practices in light of new findings. Gottschlich et al (p 1261) note that health professionals often fail to recognize that obese bum patients may be at increased risk of morbidity because of nutritional deficiencies. An accompanying interview describes an effective nutrition care plan for obese burn patients (p 1263). Heaney sheds new light on the interrelationships of calcium, protein, and phosphorus and recommends using a protein:calcium ratio to assess dietary adequacy (p 1259). We must also take a second look at the issue of fortification. Gussow and Akabas (p 1300) pose the throught-provoking question of whether the current trend toward fortifying foods is really helping the diets of American people or merely making them experts in the "trade-off"' mentality. Finally, King (p 1269) points out the alarming lack of data on the legal accountability of dietitians for professional negligence. With new data and new interpretations in all aspects of dietetics, we can become even more effective in achieving our goal of implementing dietary changes to improve health and promote wellness among the American people. ELAINE R. MONSEN, PhD, RD
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1248 / NOVEMBER 1993 VOLUME 93 NUMBER 11
BOARD OF EDITORS Judith V. Anderson, DrPH, RD, MichiganDepartment of Public Health, Lansing Susan I. Barr, PhD, University of British Columbia, Vancouver Mary Ruth Bedford, PhD), RD, Consultant,El Paso, Tex Sue Brady, DMSc, RD, James Whitcomb Riley Hospital, Indiana University Medical Center, Indianapolis Linda J. Brinkley, RD, University of Texas HealthSciences Center, Dallas Martha T. Conklin, PhD, RD, MontclairState College, Upper Montclair, NJ Rebecca A. Dowling, PhD, RD, Rush-Presbyterian-StLuke's Medical Center, Chicago, Ill John P. Foreyt, PhD, Baylor College of Medicine, Houston, Tex Judith Gilbride, PhD, RD, New York University, New York Susan M. Krebs-Smith, PhD, RD, National CancerInstitute, Bethesda, Md Debra A. Krununel, PhD, RD, Hershey Foods Corporation,Hershey, Pa Janet McDonald, PhD, RD, US Food and Drug Administration, San Francisco,Calif Alanna Moshfegh, MS, RD, US DepartmentofAgriculture, Hyattsville, Md Suzanne P. Murphy, PhD, RD, University of California, Berkeley Debe Nagy-Nero, MS, RD, Consultant, Vancouver, Wash Grace Ostenso, PhD, RD, US House of Representatives, Washington, DC Ellen Parham, PhD, RD, Northern Illinois University, De Kalb Patt Queen Samour, MMSc, RD, New England Deaconess Hospital, Boston, Mass
Linda V.Van Horn, PhD, RD, Northwestern University Medical School, Chicago, Ill Madelyn L. Wheeler, MS, RD, Indiana University Medical Center & Diabetes Research and Training Center, Indianapolis Olivia B. Wood, MPH, RD, Purdue University, West Lafayette, Ind
Can we change diet to improve health? The high-vitamin, low-fat challenge Today, the link between diet and health is clearly established. We know that healthful eating and proper nutrition play a critical role in preventing many chronic diseases. Vitamin A is just one nutrient for which researchers are elucidating possible beneficial effects. Some data suggest that beta carotene and the antioxidants may be important anticancer agents (p 1285). As the scientific evidence comes in, the trick will be how to convince people to change habits, to put into practice what is shown to be beneficial. In February 1991 (p 162), the Journalpublished an interview in which Dean Ornish, MD, described his success at reversing coronary atherosclerosis through the use of diet (a plant-rich diet with less than 10% of energy from fat), stress management, and exercise. Ornish's program has since been endorsed by a major health insurer. Recommended diet and lifestyle changes such as these open the door for increased dietitian involvement in patient guidance. Ornish's new book, Eat More, Weigh Less, applies the same principles to weight loss. The plan, which suggests a total change in eating habits, emphasizes complex carbohydrates, and promotes consumption of beans and legumes, fruits, grains, and vegetables and only moderate amounts of low-fat commercially prepared products and low-fat dairy products. Weight loss accompanies adherence to the low-sugar, lowfat diet, which is naturally low in calories. At least two thirds of the book is devoted to recipes. Those I tried were quite flavorful, yet very low in fat and calories. Many Americans are moving to low-fat animal products or vegetarian diets. ADA's revised position on vegetarian diets (p 1317) notes that they "are healthful and nutritionally adequate when appropriately planned," and provides planning guidelines. Do Americans practice what they believe? The November Glamour features results of a healthy eating survey, which was prepared with ADA's help and completed by more than 17,000 women. Findings show that women are looking at food in a new way. Crash dieting is out; 78% exercise to lose weight. Low-fat eating is in vogue; 64% limit their fat intake. Most take time to read food labels. On the down side, eating disorders were common, and fewer than 10% ate the recommended "five-a-day" servings of fruits and vegetables. Thus, the RD's expertise and sound advice are needed now more than ever to help people implement the change to healthful eating. Connecting attitude and behavior Changing behavior is one of the dietitian's key responsibilities. However, first it is essential for researchers to understand what attitudes contribute to behavior. Robinson and coworkers (p 1311) identified the attitudes of teenage mothers toward breast-feeding in an effort to help teens recognize its advantages. Bowen et al (p 1309) looked at how current eating patterns contribute to a successful change to a low-fat diet. Dietitians employed in foodservice settings realize the importance of looking at their operation through their customers' eyes. Ouellet and Norback present a model for selecting quality standards through identifying those elements that make customers satisfied (p 1296). New data, new interpretations As health professionals we must always be willing to reexamine current practices in light of new findings. Gottschlich et al (p 1261) note that health professionals often fail to recognize that obese bum patients may be at increased risk of morbidity because of nutritional deficiencies. An accompanying interview describes an effective nutrition care plan for obese burn patients (p 1263). Heaney sheds new light on the interrelationships of calcium, protein, and phosphorus and recommends using a protein:calcium ratio to assess dietary adequacy (p 1259). We must also take a second look at the issue of fortification. Gussow and Akabas (p 1300) pose the throught-provoking question of whether the current trend toward fortifying foods is really helping the diets of American people or merely making them experts in the "trade-off"' mentality. Finally, King (p 1269) points out the alarming lack of data on the legal accountability of dietitians for professional negligence. With new data and new interpretations in all aspects of dietetics, we can become even more effective in achieving our goal of implementing dietary changes to improve health and promote wellness among the American people. ELAINE R. MONSEN, PhD, RD
&0c
; ,
e
xtl4~
1248 / NOVEMBER 1993 VOLUME 93 NUMBER 11
BOARD OF EDITORS Judith V. Anderson, DrPH, RD, MichiganDepartment of Public Health, Lansing Susan I. Barr, PhD, University of British Columbia, Vancouver Mary Ruth Bedford, PhD), RD, Consultant,El Paso, Tex Sue Brady, DMSc, RD, James Whitcomb Riley Hospital, Indiana University Medical Center, Indianapolis Linda J. Brinkley, RD, University of Texas HealthSciences Center, Dallas Martha T. Conklin, PhD, RD, MontclairState College, Upper Montclair, NJ Rebecca A. Dowling, PhD, RD, Rush-Presbyterian-StLuke's Medical Center, Chicago, Ill John P. Foreyt, PhD, Baylor College of Medicine, Houston, Tex Judith Gilbride, PhD, RD, New York University, New York Susan M. Krebs-Smith, PhD, RD, National CancerInstitute, Bethesda, Md Debra A. Krununel, PhD, RD, Hershey Foods Corporation,Hershey, Pa Janet McDonald, PhD, RD, US Food and Drug Administration, San Francisco,Calif Alanna Moshfegh, MS, RD, US DepartmentofAgriculture, Hyattsville, Md Suzanne P. Murphy, PhD, RD, University of California, Berkeley Debe Nagy-Nero, MS, RD, Consultant, Vancouver, Wash Grace Ostenso, PhD, RD, US House of Representatives, Washington, DC Ellen Parham, PhD, RD, Northern Illinois University, De Kalb Patt Queen Samour, MMSc, RD, New England Deaconess Hospital, Boston, Mass
Linda V.Van Horn, PhD, RD, Northwestern University Medical School, Chicago, Ill Madelyn L. Wheeler, MS, RD, Indiana University Medical Center & Diabetes Research and Training Center, Indianapolis Olivia B. Wood, MPH, RD, Purdue University, West Lafayette, Ind