March is National Nutrition Month. It was created in the 1970’s by the American Dietetic Association as a means of raising awareness of nutritious eating and promoting the role of registered dietitians in helping us stay lean and healthy.

The ADA website has a special section dedicated to “NNM”. In it, some  interesting features, including an interactive history of fad diets and a rather lame interactive quiz. Plus a ton of educational materials and suggestions.

What you need to know:

Unfortunately, despite the ADA’s efforts, obesity rates have skyrocketed in the last decades. There are many reasons for this, including gargantuan budgets for marketing by the food industry, versus very tiny budgets of health and diet groups. When was the last time you saw a 30 second commercial for healthy eating? But you mostly likely saw 50 fast food and junk food spots just in the last week.

Additionally, human nature is such that it’s easier to buy cheap and tasty junk food  rather than prepare your own healthy food at home.

Visiting a dietitian for a consultation is so expensive ($100-200 an hour), that most people can’t afford it. Only if you become diabetic or your kidneys fail does your health insurance kick in and allow you to see an RD.

Should the ADA be much more aggressive in its activities and position on diet related issues? Take a look at how PETA manages to create awareness to their cause through creative marketing and absolutely no limitations imposed by industry sponsorships. Unfortunately, the ADA receives donations from corporate sponsors, that may have an effect on the types of messages sent out to the public, and if not that, at least their tone.

Here’s an example:

If you consult with a dietitian wanting to lose weight, one of the first and easiest suggestions is to switch from soft drinks and juices to plain water. However, as a collective, it is hard for the ADA to come out with such a message because the organization is sponsored by Coca Cola and Pepsi. That’s why you’ll get a watered-down message (reverse pun intended) talking about “consuming in moderation”.

What do you think the ADA can do to really make an impact on America’s waistline?

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This is a guest blog post by Jenny Westerkamp, RD

The dietetics profession has changed in the last century, alongside our nation’s eating habits. Different demand, such as increased need for weight loss solutions — stemming from obesity epidemic — mean different kinds of supply such as dietitians that specialize in weight loss, write weight loss books, are spokespeople for weight loss companies, etc. The possibilities are endless — and that’s awesome.

When I started studying dietetics in college, I was unsure of what I would do with my chosen career path. Clinical nutrition is where a majority of dietitians find careers. As I went through my dietetic internship (which ended three months ago), my soon-to-be-defined passion slowly grew with each ill patient that walked through the dietitian’s door.

How do I PREVENT people from getting diseases so that they don’t have to see this dietitian? How do I stop the downward slope that people slide on when they follow the standard American diet full of processed foods?

I knew that dietitians play a critical role on the healthcare team once people get diagnosed with these diseases/conditions. But where were dietitians many years ago when these patients began eating poor quality diets? Isn’t diet more often than not a cause of these diseases?

Was I being too optimistic to think that providing prevention through good nutrition was a possible and respectable mission?

Every patient that I met during my internship year—suffering from obesity, Type 2 diabetes, cardiovascular disease, or any other preventable chronic disease—was a source of inspiration for a career in prevention.

There is a sense of urgency among young dietitians right now, myself included. Something tells me if we don’t start preventing chronic diseases TODAY, there will not be enough dietitians to effectively manage all the sick people tomorrow! My hope is that young dietitians realize these opportunities outside of the hospital halls and join in on the prevention conversation that people have everyday about food and nutrition.

Unfortunately, young dietitians up against a culture (and clientele) that is hard to please. And it’s getting worse.

1. First, clients wanted easy. Now they want effortless.

2. Once, they wanted quick results. Now they want immediate results.

3. Any solution also had to be cheap. Now, even cheap is too much to invest in their health.

People are quickly losing grip on the lifestyle that can keep them and their families from spending money later on. It’s too bad prevention is not the trendy thing to do – that would certainly help this cause.

Dietitians possess powerful, life-changing, life-saving information that so many—TOO many—people don’t want to know about until it is too late. It is terribly sad to know that those who aren’t investing wisely in their health will be more likely to have a chronic disease. My mission is to find those people before chronic illness finds them.

So many people to save, so little time…And that’s this young dietitian’s dilemma.

Jenny Westerkamp, RD is a sports nutritionist for SportFuel and a nutrition consultant for an organic meal delivery service, Eat Like the Pros, based out of Chicago. She is the co-founder of All Access Internships, an online resource and community for dietetics students. For more on Jenny or if you want to ask her what you should be eating, visit her blog “Trendy Nutrition” at jennywesterkamp.com.

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We’ve concluded a 4 day nutrition and food conference and expo (FNCE 2009) hosted by the American Dietetic Association. For a first time participant, such a convention may seem a bit overwhelming, but it does provide a great opportunity to learn about the current state of affairs in the world of nutrition and food.

Random observations:

1. The people. RDs are probably the nicest bunch of people one can get to know. That makes the participation in the event a real treat.

2. Conflict of Interest. The presence and influence of the food industry was pervasive and worrisome. From the moment one stepped into the conference center, she was greeted with huge signs thanking corporate sponsors such as Coca Cola, Unilever, and Mars. The logos of the sponsors were plastered on each of the swag bags the participants received at registration.

The conference is divided into many simultaneous educational sessions on various nutrition topics, as well as a food expo. Several of the educational sessions were also sponsored by food companies. For example, Coke sponsored a session entitled Children’s Dietary Recommendations:urban myths, parental perceptions, and scientific evidence. Guess what the speaker had to say: Artificial colors are fine, artificial sweeteners are fine, and sugar does not cause obesity.

Especially troubling was the fact that so many young RDs and students participate in the program and are ingrained to accept these conflicts of interest as matter of fact. If the American Dietetic Association stays this course, the public credibility of dietitians as a group will suffer. (See Smart Choices Program as just one example).

3. In moderation. We can’t count the number of time we’ve been told that snack A or drink B should be consumed in moderation. If we hear that word one more time, we’ll just drown somebody in a bucket full of “discretionary” calories. Whenever junk food processors are with their back with the wall, they pull their “it’s in fine in moderation” card. You know what – it’s not.

Here’s why – Each manufacturer of junk food or beverage is vying for the 10% discretionary calories a person can consume in a day. That works out to approximately 150 calories for a growing child. Unfortunately, a can of Coke is XXX. But is little Johnny “discretionating” with just that one can for a whole day? Heck no! What about the morning Sweetened cereal? And the potato chips for lunch? The sugar sweetened lunch milk? The afternoon cookies? And Jello for dessert? There is no moderation because too many manufacturers need to sell us too much crap.

4. State of Emergency. With the rising rate of obesity, one would have expected to feel a heightened sense of urgency at the conference. Perhaps we did not participate in the right lectures and presentations, but the overall atmosphere seemed to be business-as-usual.

That said, FNCE 2009 was a great learning experience and a wonderful opportunity to meet the folks working “in the trenches”. We look forward to next years conference in Boston.

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This is a follow-up to our previous post which posed a provocative question – who contributes more to your health, doctors or dietitians?

We’ve gotten insightful feedback from Joan Endyke, MS, LDN, CPT, that we’d like to share:

1. Nutrition Training in Medical School.  Some med schools are incorporating more nutrition ed into their programs. This is great because currently some doctors’  “advice” regarding weight loss and food recommendations is appalling. But even with more nutrition ed in med school, unfortunately doctors do not have the time to listen to a patient and teach him how to change his food habits.

2. It takes more than a 10 minute visit…Dietitians typically spend an hour in an intro meeting with a client to be able to really pinpoint a person’s variables: Is it lack of knowledge? Emotional overeating? Poor planning? Which nutrients are in excess? Which are likely deficient?

During the next visit (another full hour) a good dietitian breaks down the findings, explain the physiological reasoning behind the recommendations (people don’t just want to be told what to eat, they want advice so they are able to make their own informed decisions & their habits are likely to last this way too). Lastly comes  the tricky part – realistic food choices that match a person’s job schedule, family life, activity, income, time available, etc.

This can occur with frequent, consistent follow-up to enable one to develop and maintain the right habits with continued support and advice. All of this takes TIME as well as a skilled professional – but it is well worth it in the end.

3. Health Insurance. The CDC has made “overweight” a billable medical diagnosis. Many health insurance companies allow nutrition visits now, and dietitians are able to capture overweight clients before they develop a chronic condition. HOWEVER, some insurance companies limit individuals to 2 or 3 visits per year. This is really ineffective because these scarce visits do not provide enough face-time with a dietitian for most people to change habits.

This should be remedied. Preventive care should be generously available to all via a mandate and co-payments should be reasonable. Yet clients should also have to show they are committed and making progress to continue to use those health care dollars. This can be done with a quick assessment sent to the insurance company or family physician from the RD.

4. Personal Responsibility and Incentives. In Joan’s opinion, the consumer needs to bear more responsibility in this health care mess – you can’t just blame the health insurers and doctors.

Financial incentives targeting consumer would help shift some of this. People pay more for life insurance if they have high cholesterol or are overweight. Young or reckless drives have increased car insurance rates. Similarly, people who choose to smoke, not manage their weight, cholesterol, blood pressure, etc. should pay a higher premium. If and when they have managed those conditions, the premium should be lowered.

Or it could be a tax incentive for hitting your “health goals.” The proof could be a standard assessment signed off by an MD. There is only so much a dietitian or a doctor can do – individuals need to make the changes. But they should be allowed visits with a dietitian to help them. If they choose not to – that’s fine, it’s a free country, but others should not have to bear the burden of their likely use of greater health care dollars in the long run.

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Benjamin Franklin once said that an ounce of prevention is worth a pound of cure. Let’s frame that quote into the context of this country’s current obesity crisis.

According to recent reports, obesity is responsible for about 10% of healthcare costs in the US, an estimated $147,000,000,000 (that’s 147 billion) annually.

And while our highly trained, very capable doctors can help cure, fix, and medicate a patient, a good dietitian may help a client avoid the illness in the first place. (Notice the nomenclature – patient vs client).

If you think your doctor can give you some diet tips, know this – the average physician does not receive a single credit’s worth of nutrition education while at medical school.  So when a doctor tells you to lose some weight, she does not necessarily have the tools to help you make it happen.

The US has over 550,000 doctors but less than 70,000 dietitians. The average annual salary of a physician in the US is $200,000, but the average dietitian will see less than a quarter of that amount, $49,000.

Using some very crude math, let’s assume that 10% of healthcare cost translates to 10% of doctors or 55,000 MDs. What if we magically retrained those doctors and added a nutrition degree to their quiver of skills? Would this reduce  the number of obesity related diseases by 10%?

This is all wishful thinking, because in the US today there is no direct incentive to engage in even half an ounce of prevention. It’s much more profitable to create health problems (fast food industry, junk food manufacturers) and then spend billions to cure them (Medical bills, pharmaceuticals). It’s a profitable business cycle for corporations, but not a sound proposition for consumers.

This is not in any way meant to be a lash out at doctors, who do their jobs tirelessly and loyally. It’s just that doctors are great at helping sick people, mostly after the fact. Pre-emptive care is undervalued today because there is no financial incentive in the current business ecosystem to help keep people lean and fit. In fact, dietetic consultations are not necessarily covered by health insurance.

What can be done?

Policymakers should create financial incentives for industries to prevent people from getting fat and sick. Medical schools should see find ways to integrate nutrition education into their syllabus.

If you are a young, talented and ambitious college student who wants to help people be healthy, where do you think you’ll have more impact? Shoot away in the comments below.

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Flickr Photo: stu_spivack

Prevention magazine presents 8 foods hyped and marketed as healthy, when actually, they’re not:

“From a distance, some foods seem like healthful choices because of the way they’re packaged or labeled,” says Janel Ovrut, MS, RD, a Boston-based dietitian. “But just because a product’s marketing gives it an aura of health doesn’t necessarily mean it’s good for you.”

The list includes:

* Baked potato chips. Better for you: Popcorn
* Gummy fruit snacks. Little fruit, lots of sugar. Better: Fresh/dried fruit
* Diet soda. Better: Flavored seltzer water
* Low-fat cookies. Low-Fat is a codeword for lots of sugar. Better: Oatmeal Cookies.

Read the full article…

What you need to know:

The less a food is processed, the more likely it is to be better for you. It retains the original vitamins and minerals. Trying to reduce fat by replacing it with sugars is not going to help you lose weight or improve your health.

A healthy candy bar is simply an oxymoron. When you do want to indulge, do so with the tastiest ice cream or candy without remorse. Just don’t do it too often.

What to do at the supermarket:

Don’t bother reading the health claims. Check the nutrition label and ingredient list to get the real picture.

flickr photo: Brian Forbes

2008 is almost over. 2009 is upon us. An ending. A new beginning.

A chance to reflect on what we did and what we learned. A moment to plan ahead and set goals.

How are you planning to improve your sustenance?

We urge you to think not only of nutrition for your body, but how to nurture your soul. Eating should be elevated to dining. Spend time with your family and friends in choosing, preparing, and enjoying food. Don’t just grab and go. Savor the bounty of the earth. Chew slowly. Be thankful.

Here are ten food related suggestions, from ten dietitians, courtesy of the Atlanta Journal-Constitution:

“Kiss and make up with food this year. Live at peace with food and don’t fear it. Invite healthier choices into your meals and worry less about what to avoid so you will be healthier and happier.”
— Dave Grotto, Author of “101 Foods That Could Save Your Life!” Chicago

“Forget about diets and focus on choosing wholesome, natural and less processed foods. Enjoying more whole foods that contain plenty of fiber like nuts, beans, fruits and vegetables to help you feel full so there is less room for empty calories that pack on the pounds.”
— Kathleen Zelman, director of nutrition, WebMD, Atlanta

“Go green. Enjoy a green vegetable every day of the year.”
— Wahida Karmally, The Irving Institute for Clinical and Translational Research, Columbia University, New York

7 more recommendations here…

The Daily Breeze reports on finding from a California study, where only a third of 46,000 respondents said they received dietary and fitness advice from their doctors:

New findings from one of the most comprehensive health surveys in the nation may shed light on one of the reasons obesity and diabetes are tough problems to solve – primary care physicians, the main gatekeepers of health information, aren’t talking enough about the need for good nutrition and exercise.

read more..

What you need to know:

Most doctors are untrained in providing nutritional advice, a job best left to dietitians. There is a wealth of dietary advice freely available on the web, take advantage of it.

What to look for in the supermarket:

Choose more foods in the perimeter aisles – fruits and vegetables, low fat milk products, and lean mets. Choose less of processed foods, sugary drinks, and highly processed snack foods.