9th
Transforming Leadership, Policy, and Practice
National Forum for Heart Disease & Stroke Prevention
September 22, 2011
The 2010 Dietary Guidelines for
Americans: Process and
Recommendations
Robert C. Post, PhD, Med, MSc
Deputy Director
Center for Nutrition Policy and Promotion
United States Department of Agriculture
Linda Van Horn, PhD, RD
Professor, Department of Preventive Medicine
Feinberg School of Medicine
Northwestern University
Challenges We Face
The Heavy Toll of Diet-Related Chronic Diseases
 81.1 million Americans—37% of the population—have
cardiovascular disease
 74.5 million Americans—34% of adults—have
hypertension and 36% of adults have pre-hypertension
 Nearly 24 million adults—11% of adults—have
diabetes
 About 41% of the population will have cancer during
their lifetime
 One out of every 2 women and 1 of 4 men will have an
osteoporosis-related fracture in their lifetime.
Robert C. Post, Center for Nutrition Policy and Promotion, USDA
Dietary Guidelines for Americans
History 1980 – 2010
2000
2010
1990
1980
2005
1985
1995
What are the Dietary Guidelines for
Americans?
• Since 1980, Federal nutrition policy established jointly by USDA
& HHS
• Updated every 5 years
• Provide science-based advice for ages 2 and over, including
those at increased risk of chronic disease to promote health
• Foundation for Federal nutrition programs, nutrition education
programs, nutrition promotion, and a basis for research gaps
and priorities
• Ensure that messages and materials are consistent through-out
the Federal government and that government speaks with
“one nutrition voice”
• Policy used by educators, health professionals, policy makers –
in public and private sector – applied and amplified in
guidance, standards, education, outreach for consumers
Robert C. Post, Center for Nutrition Policy and Promotion, USDA
Goals of Dietary Guidelines
•
•
•
•
Define a healthy diet
Provide healthy options
Promote healthy choices
Increase public awareness and demand for
choices
• Stimulate innovation for re-formulating food
products and creating healthier ones
• Strengthen the collaboration between food
scientists and nutritionists
Robert C. Post, Center for Nutrition Policy and Promotion, USDA
Development of Dietary Guidelines Policy
and Communications
Phase 1
DGAC
Charter
DGAC Public
Meetings: Review of
Science
Phase 2
DGAC Report
Submitted to
Secretaries of
USDA & HHS
USDA & HHS
Develop
DGA’s Implemented
Policy
through Federal
Document
Programs
Phase 3
Four- year process to develop the DGA
Phase 4
2010: Landmark Advances in Access to and
Evaluation of Nutrition Literature
USDA’s Nutrition
Evidence Library
www.NutritionEvidenceLibrary.gov
Other systematic
reviews/reports:
•PA Guidelines
•DRIs
•Federal Reports
•Others
2010 DGAC
Report
Food pattern
modeling
Dietary intake
analyses
Public
Comments
(e.g., consumption
trends/calorie intake by
groups )
Nutrition Evidence Library (NEL)
Evidence-Based Methodology
 Rigorous
 Minimizes bias
 Transparent
 Accessible to stakeholders/consumers
 Defines state of the science
 Foundation for updates
www.NutritionEvidenceLibrary.gov
Answers precise questions – Illuminates research gaps
Public Comments
Public comments—written and oral
– Throughout the DGAC deliberation process, as well as after the
release of their Report
– Available online at www.dietaryguidelines.gov
– Over 100 organizations or individuals provided oral testimony at
public meetings
• To the DGAC on their work or
• To the government on the DGAC’s final Advisory Report
– Over 1100 written on the Advisory Report alone
– Comments taken into consideration as part of the development
process for both the Advisory Report and the policy document
 USDA and HHS Agencies reviewed Advisory Report for
potential program-specific policy implications
All comments available for viewing at www.dietaryguidelines.gov
Dietary Guidelines
Development Process
Drafting and Vetting of The Dietary Guidelines
 Writing team:
– USDA and HHS nutritionists -- most who worked closely with the
DGAC in developing the Report
– Structure for DGA followed the four main integrated findings
identified in the DGAC Report’s Translation and Integration
Chapter
 Reviews of policy document drafts:
– USDA and HHS Agency review for policy implications
– Independent peer review for compliance with Quality of
Information Act for clarity, technical accuracy, and consistency
with the Advisory Report
– Clearance through the Departments in December 2010
Transparency and inclusiveness through review process
2010 Dietary Guidelines
at a Glance
•
•
•
•
•
•
•
•
Executive Summary
Chapter 1. Introduction
Chapter 2. Balancing Calories to
Manage Weight
Chapter 3. Foods and Food
Components to Reduce
Chapter 4. Foods and Nutrients to
Increase
Chapter 5. Building Healthy Eating
Patterns
Chapter 6. Helping Americans
Make Healthy Choices
Appendices
Linda Van Horn, Northwestern University
2010 Dietary Guidelines
Highlights
 Policy Document
– Includes 23 key recommendations for the general
population and 6 for subpopulation groups
– Organized to present information in an integrated
way
 Two Overarching Concepts
– Maintain calorie balance over time to achieve and
sustain a healthy weight
– Focus on consuming nutrient-dense foods and
beverages
Linda Van Horn, Northwestern University
2010 Dietary Guidelines Concept:
Balancing Calories to Manage Weight
• Epidemic of overweight and obesity in all segments of
our society
• Environmental factors contribute to weight gain
•
•
Calorie balance over time is key
Important modifiable factors
• Calories consumed in foods and beverages
• Calories expended in physical activity
• Strong evidence for no optimal proportion of
macronutrients for weight loss
Linda Van Horn, Northwestern University
Top Sources of Calories
Among Americans 2 Years and Older
1. Grain-based desserts (6% of calories)
• Cake, cookies, pie, cobbler, sweet rolls, pastries, and donuts
2. Yeast breads (6% of calories)
• White bread and rolls, mixed-grain bread, flavored bread,
whole-wheat bread, and bagels
3. Chicken and chicken mixed dishes (6% of calories)
• Fried and baked chicken parts, chicken strips/patties, stir-fries,
casseroles, sandwiches, salads, and other chicken mixed
dishes
4. Soda/energy/sports drinks (5% of calories)
• Sodas, energy drinks, sports drinks, and sweetened bottled
water including vitamin water
5. Pizza (5% of calories)
Approximately 28% of total calories!
Linda Van Horn, Northwestern University
Principles for Promoting Calorie Balance
in Food and Beverage Intake
• Self-monitor food and beverage energy intake, physical activity,
and body weight
• Reduce portion sizes
• When eating out, make better choices / reduce portions
• Limit screen time
• Make more nutrient-dense choices; nutrient dense breakfast.
Reduce /omit energy dense/ nutrient poor choices.
• Know calorie needs and limit intake
• Place individual food choices into total diet/overall eating
pattern
Linda Van Horn, Northwestern University
2010 Dietary Guidelines Concept:
Focus on Consuming Nutrient-Dense Foods
and Beverages
 Reduce intake of foods and beverages high in solid fats,* added
sugars, and sodium (snacks, desserts, SSBs)
– Replace with nutrient-dense foods and beverages
 Nutrient Dense foods include:
– Vegetables and fruits
– Whole grains
– Fat-free and low-fat dairy products
– Seafood (reduces lean meat/poultry in food patterns))
 Choose nutrient dense foods, but stay within calorie needs
*Solid fats are major sources of saturated fats, trans fats, and cholesterol
Linda Van Horn, Northwestern University
Foods and Food Components
to Reduce - Sodium
•
•
•
•
Current Average intake = 3440 mg/day
Reduce intake to less than 2300 mg per day
Further reduce intake to 1500 mg per day for
• Adults ages 51+
• African Americans ages 2+
• People ages 2+ with high blood pressure, diabetes, or
chronic kidney disease
The 1500 mg recommendation applies to half the total
population (ages 2+) and to the majority of adults
Immediate, deliberate reduction in sodium content of
foods is needed
Linda Van Horn, Northwestern University
Food Sources of Sodium
Linda Van Horn, Northwestern University
Foods and Food Components to Reduce
Current average intakes:
Total fat
34% of calories
Saturated fat 11% of calories
Cholesterol
350 mg/ day for men & 240 mg/d for women
Recommendations:

Saturated fatty acids—less than 10% of calories
 Less than 7% reduces risk of CVD further
 Replace with poly- and monounsaturated fatty acids (not with sugar or
refined grain)


Trans fats—as low as possible
Cholesterol—less than 300 mg per day
 Effect on CVD small compared to saturated and trans fats
 Egg yolks (25mg cholesterol?) —up to 1 per day
Linda Van Horn, Northwestern University
Food Sources of Saturated Fats
Foods and Food Components to Reduce
Calories from solid fats and added sugars
Currently, solid fats and added sugars (SoFAS) provide
35% of calories/ day, but do not contribute nutrients
Recommendations:
■ Reduce intake of calories from SoFAS
■ No more than 5 to 15% of calories from SoFAS can
be accommodated in healthy diets
■ As the amount of solid fats and/or added sugars
increases, the intake of sufficient dietary fiber and
essential vitamins and minerals decreases within
calorie limits.
Linda Van Horn, Northwestern University
Foods and Food Components to Reduce
Refined grains
■ Average intake is 6.3 oz-eq/d
■ Recommended level no more than 3 x 1oz-eq/d (2000
calorie level in the USDA Food Pattern)
■ Limit consumption of refined grains, especially those
that contain solid fats, added sugars, and sodium new
■ Enriched refined grain products provide some vitamins
and minerals, but not the fiber provided by whole
grains
■ Replace refined grains with whole grains
Linda Van Horn, Northwestern University
Food Sources of Refined Grains
Comparison of Consumption
to Recommendations
Linda Van Horn, Northwestern University
Summary
2010 Dietary Guidelines for Americans
•
Evidence-based nutritional guidance
• Promote health
• Reduce the risk of chronic diseases
• Reduce the prevalence of overweight and obesity
•
Integrated set of advice for overall eating pattern
Resources
•
www.DietaryGuidelines.gov
• Policy document/Q’s and A’s, selected consumer messages
• Advisory Committee Report
•
www.NutritionEvidenceLibrary.gov
Linda Van Horn, Northwestern University
Applications of the
2010 Dietary Guidelines
Robert C. Post, Center for Nutrition Policy and Promotion, USDA
2010 Dietary Guidelines: Applications
USDA
• Food and Nutrition Service
– SNAP (formerly Food Stamps)
– WIC
– National School Lunch Program
• Food Safety and Inspection Service
– Nutrition Facts labeling
– Food safety education
• Center for Nutrition Policy and Promotion
– USDA Food Plans (Thrifty, Low-cost, Liberal)
– USDA Food Patterns
– Healthy Eating Index (HEI)
Robert C. Post, Center for Nutrition Policy and Promotion, USDA
2010 Dietary Guidelines: Applications
HHS
• Centers for Disease Control and Prevention
– Fruits & Veggies – More Matters
• Food and Drug Administration
– Front of pack and other nutrition labeling
• National Institutes of Health
– WECAN!
– NHLBI’s DASH Eating Plan
• Office of Disease Prevention and Health Promotion
– Healthy People 2020
Robert C. Post, Center for Nutrition Policy and Promotion, USDA
2010 Dietary Guidelines: Applications
Public & Private Sectors
• Non-profits
– Develop materials that translate the Guidelines for their areas of
expertise with focus for target audiences
• Food industry
– Ex. Lower sodium food formulations
• Community coalitions
– Nutrition education where Americans live, work, and play
• Teaching Institutions
– Public and professional education for translating the Guidelines
for the public
Robert C. Post, Center for Nutrition Policy and Promotion, USDA
New Dietary Guidelines Lead to a New
Symbol for Thinking About Healthy Eating
June
2011
January
2011
2010 Dietary
Guidelines for
Americans (DGA)
released
DGA
selected
messages
for
consumers
released
September
2011 and
beyond…
MyPlate
unveiled
Nutrition
Communicators
Network
launched
Robert C. Post, Center for Nutrition Policy and Promotion, USDA
MyPlate
multi-modal
communications
initiative launched
What
the IconIcon
Is
The MyPlate
■ A new take on a familiar mealtime symbol.
■ A cue to help consumers think about making
healthy choices.
■ Symbolizes a need to build a healthy plate
based on the food groups.
■ Will be accompanied by a broader effort to help
consumers choose a healthy diet.
Robert C. Post, Center for Nutrition Policy and Promotion, USDA
The
Campaign
ThMyPlate
Campaign
A multi-modal approach is needed to sustain momentum
and ultimately change behavior.
Coordinated Messaging,
MyPlate icon, and
“How-tos”
Multi-modal
Approach
Partnerships
Social Media and “Buzz”
Activities
Interactive Tools and
Resources to Apply the
DGA @
ChooseMyPlate.gov
Robert C. Post, Center for Nutrition Policy and Promotion, USDA
Selected DGA Consumer Messages:
Campaign Calendar
Release a multi-year strategy to coordinate and streamline
messages to the public.
Dates
2010 DGA Theme
Selected Key Message
Sept. – Dec. 2011
Foods to Increase
Make half your plate fruits and vegetables.
Jan. – April 2012
Balancing Calories
Enjoy your food, but eat less.
May – Aug. 2012
Foods to Reduce
Drink water instead of sugary drinks.
Sept. – Dec. 2012
Foods to Increase
Make at least half your grains whole grains.
Jan. – April 2013
Balancing Calories
Avoid oversized portions.
May – Aug. 2013
Foods to Reduce
Compare sodium in foods like soup, bread, and
frozen meals – and choose the foods with lower
numbers.
Sept. – Dec. 2013
Foods to Increase
Switch to fat-free or low-fat (1%) milk.
“How-tos” to Fit Every Lifestyle
Demonstrate how consumers can apply the
Guidelines to their lives.
•
“10 Tips Nutrition Education Series”
•
Consumer Brochure
• Posters
•
Videos and video competition
•
Menus
•
Recipes
•
Online Information and Interactive Tools
Robert C. Post, Center for Nutrition Policy and Promotion, USDA
Partnerships
Nutrition Communicators Network provides and
amplifies how-tos for consumers!
A partner category for every
organization:
•
•
Community Partners
National Strategic Partners
Underscores the importance of reaching
consumers BOTH on a community level and a
national level!
Robert C. Post, Center for Nutrition Policy and Promotion, USDA
What’s New on MyPlate?
ANNOUNCING:
■ MiPlato and Spanish language materials
■ Consumer video competition launch
■ SuperTracker Tool
■ Redesigned ChooseMyPlate.gov website
■ Campaign and partnership milestones
Robert C. Post, Center for Nutrition Policy and Promotion, USDA
The Nutrition/Health Community
■ Important in developing and disseminating how-tos to help
various audiences apply the DGA consumer messages
■ Imagine the potential impact on consumer behavior if the
entire health community focused on one message/behavior
at a time……….
Robert C. Post, Center for Nutrition Policy and Promotion, USDA
What You Can Do
 Promote 2010 Guidelines
 Become a Community
messages with USDA through Partner
timed, coordinated releases
 Use new MyPlate food
icon
 Drive consumers to the tips,
resources, and tools at
ChooseMyPlate.gov
 Supplement the 2010
Guidelines messages with
how-tos that appeal to your
audience
Robert C. Post, Center for Nutrition Policy and Promotion, USDA
Ideas for Getting Started Now
• Link to ChooseMyPlate.gov
and web materials
• Feature MyPlate icon on
website and materials
• Develop public service
announcements
• Produce ChooseMyPlate.gov
placemats
• Create videos
• Coordinate challenges or
contests in your community
• Showcase your work at
individual message launches
• Use social media to get the
word out
• Develop mobile applications
• Create educational materials,
resources, curriculum, and
tools
• Share healthy MyPlate photos
and pictures
• Create recipes/menus
following the Dietary
Guidelines
• Feature messages in
advertising, point-of-purchase,
and media
• Evaluate message
dissemination and/or program
reach
Robert C. Post, Center for Nutrition Policy and Promotion, USDA
Desired Outcomes
■ Expansive delivery of solid evidence-based
recommendations
■ Consistent, sustained communication using relevant
messages is key in helping consumers achieve healthy diets
and lifestyles
■ Dietitians and other health professional partners are vital
to empower consumers and reach diverse audiences with
how-tos that resonate
■ Evaluation will be vital!
Robert C. Post, Center for Nutrition Policy and Promotion, USDA
Questions?
Robert C. Post, Center for Nutrition Policy and Promotion, USDA
Linda Van Horn, Northwestern University