Pat Crawford, DrPH, RD

CE Specialist

Sr. Director of Research

Nutrition Policy Institute UCANR

And Co-founder and Director

Atkins Center for Weight & Health

UC Berkeley

US Dietary GuidelinesA Road Map

with a Detour

In 2014 UC ANR founded the UCANR Nutrition

Policy Institute (NPI)

Lorrene Ritchie, PhD, RD; Director of Research at the

Atkins Center for Weight & Health was selected as the

Director.

In July 2015, I moved to NPI with staff and projects.

Nutrition Policy Institute was created

Prevention of:

food insecurity

obesity

diabetes

Promotion of:

healthy eating & activity

Targeted to:

low-resource communities

children and families

What topics does NPI focus on?

US is #1 in Obesity

2/3 of adults overweight or obese

30 year increase in prevalence of child obesity (ages 6-19 years)

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

1975 1980 1985 1995 2000 2005

NHANES, 2012-2014

1/3 of our children are

overweight or obese

This is a bigger story than obesity

Diabetes and pre-diabetes in adolescence

are rising

9%

23%

0

5

10

15

20

25

2001 2009

May, 2012. Pediatrics NHANES

THE SCIENCE OF FAT

After ‘The Biggest Loser,’ TheirBodies Fought to Regain Weight

Contestants lost hundreds of pounds during Season 8, but gained them back. A study

of their struggles helps explain why so many people fail to keep off the weight they lose.

By GINA KOLATA MAY 2, 2016

Why

Diet quality in the US

Wang DD, et al. JAMA. 2014

1

6

11

16

21

26

31

36

41

46

1999-2008 2009-2010

Low SES Med SES High SES

Dietary Guidelines for Americans

Our nation’s nutrition policy and

nutrition education “backbone”

1980 – 1st

2015 – 8th

DGAC Tasks

Formulate research questions

Analyze evidence

Answer questions

Make recommendations for action

USDA’s nutrition evidence library

www.nutritionevidencelibrary.com

Acceleration in nutrition research

0

5000

10000

15000

20000

1980 1985 1990 1995 2000 2005 2010 2014

Evidence analysis process

Nutrition

Evidence

Library

Process

Systematic

Reviews &

Meta-

Analyses

Primary

Data

Analysis

27%

45%

30%

The scientific report guiding the US

dietary guidelines: is it scientific?IT HAS A BIG IMPACT ON THE DIET OF AMERICAN CITIZENS, AND

THOSE OF MOST WESTERN NATIONS, SO WHY DOES THE EXPERT

ADVICE UNDERPINNING US GOVERNMENT DIETARY GUIDELINES

NOT TAKE ACCOUNT OF ALL THE RELEVANT SCIENTIFIC

EVIDENCE?

NINA TEICHOLZ JOURNALIST, NEW YORK CITY, USA

British Med Journal 2015;351:h4962

Advantages Considerations

Resource intensive

Time-consuming

Evidence examined

depends on

question asked

Systematic

Thorough

Inclusive of all

study designs

Transparent

Minimizes bias

Dietary Guidelines 2015 Topics

• Food and nutrient intakes, and health: current status

and trends;

• Dietary patterns, foods and nutrients, and health

outcomes;

• Individual diet and physical activity behavior change

• Food environment and settings

• Food sustainability and safety

• Cross-cutting topics of public health importance

• Physical activity

Dietary Guidelines Overarching Themes

• The problem - ~1/2 of Americans have > 1 preventable disease related to diet and physical activity;

• The gap: food consumption patterns are poor;

• Dietary patterns: no specific diet recommended but healthy patterns of intake are clear;

• The individual: counseling, group education and proven tools, new technology should be used;

• The long-term view: recommended dietary patterns must be sustainable for the population and planet;

• The population: policy and environmental initiatives are effectively changing diet and physical activity.

School policy change and student BMI change

in California

Ref: Sanchez-Vaznaugh, Crawford, 2010

• Annualize the adjusted decrease in prevalence

Assume that annual decrease continues until 2015

• Apply this to ALL kids in CA

• ~ 100,000 kids DROP OUT of the obese category

• Assuming a savings of at least $220 per child**

• State savings of more than $20 million

Estimated medical cost

savings/child*

* Madsen K, UC Berkeley, personal communication

**(based on MEPS data from 2001 to 2003, as reported in NY state comptroller

report from Oct 2012)

Selected recommendations

• Think prevention at individual level

• Most people would benefit from reducing consumption of red and processed meats, refined grains, added sugars, sodium, and saturated fat;

• Nutrients should be obtained through healthy foods rather than supplements.

• Seek help from nutrition and exercise experts as needed.

• Pay special attention that children eat healthy foods.

• Make healthy lifestyles and disease prevention local and national priorities.

• Seek a paradigm shift in health care and public health toward a greater focus on prevention and in school and early childhood environments

• Establish healthy food environments

• Implement Nutrition Facts labels and Front-of-Package labelsto help consumers.

• Questioning the players, the topics, the entire process may

undermine scientific underpinnings of the DGA.

• Sustainability issue removed in its entirety

• Recommendation to reduce red meat and processed meat

changed to men and adolescent boys who consume high

levels of meat should reduce consumption.

• Specifics on sugar sweetened beverages de-emphasized in

final report

• Water promotion de-emphasized in final report.

The Detour

Big take away: Calories from added

sugars…

• Should be limited to no more than 10% of total

calories/day

• High sugar intake is associated with risk of obesity,

heart disease and diabetes

• HFCS, agave, honey, dextrose, turbinado, molasses,

sucrose, fructose, evaporated cane juice

Big take away: Sodium

should be consumed at less

than 2300 milligrams/per day

for the general population (14 years and older).

Sodium intake has a linear

relationship with blood pressure.

Big take-away: Replacing saturated fats with

polyunsaturated fats is associated with

reduced risk of cardiovascular disease events

and death.

As before, consume less than 10% of calories

from saturated fats.

Change: limiting dietary cholesterol to 300

mg/day was not included in the new

guidelines!

Take away: Dietary patterns of the

following composition are associated with

healthier weight lower risk of obesity and

good health:o High in vegetables, fruit, whole grains, unsaturated fats

o Inclusive of seafood and legumes

o Moderate in low and non-fat dairy products

o Low in meat (particularly processed and red), sugar-

sweetened foods/beverages, refined grains, saturated

fats, cholesterol, sodium

“Never before has the evidence linking

diet to health been stronger”

Thank you