American Dietetic Association
Position and Practice Papers
American Dietetic Association (ADA) position and practice
papers assist in promoting the public’s optimal nutrition,
health, and well-being. Both position and practice papers are
germane to ADA’s vision, mission, values, goals, and strategies.
What is an ADA position paper?
A position paper is a critical analysis of current facts, data, and
research literature. A key feature of the paper is the position
statement, which presents ADA’s stance on an issue. ADA and
its members, other professional associations, government
agencies, and industry use position papers to shape food
choices and impact the public’s nutritional status. Position
papers are available to ADA members, health professionals, and
the public on ADA’s website at no charge and are published in
the Journal of the American Dietetic Association.
A position paper
• Communicates the science on current and emerging
issues important to dietetics.
• Expresses a proactive call to action to promote the public’s
optimal nutrition, health, and well-being.
What is an ADA practice paper?
A practice paper is a critical analysis of the current research
literature that addresses a practice topic to translate science
to practice. It provides registered dietitians (RDs) and dietetic
technicians, registered, (DTRs) with information to enhance
critical reasoning and quality improvement in dietetics
practice. Practice papers are available on ADA’s website at
no charge to ADA members, an important member benefit.
Practice paper abstracts are published in the Journal of the
American Dietetic Association.
A practice paper may include the following:
• ADA’s Standards of Practice and Standards of Professional
Performance
• Practice guidelines, including links to evidence-based
analysis, when available
• Description of best practices
• Implications for the Nutrition Care Process
• Decision trees
• Benchmark levels
• Practice definitions
• Opposing and emerging science
from the association
ion
ciat
asso
the
ation: Food
Associ
fromDieteti
cfrom
the
association
Position of the American
in the United States
Insecurity
Dietetic Association: Local
Position of the American
in Schools
the American
Dietetic Association:
NutritionofIntegrity
Support for Position
Nutrition Intervention and Human Immunodeficiency
Virus Infection
overarlives.” The proposed
2020
eliminate food healthy
goals of Healthy People
the United States. To
are needed, ching
preventable disease,
insecurity, interventions
for and are to eliminate
ABSTRACT
premature
American Di- including adequate funding and nu- disability, injury, and
elimiIt is the position of the
of food
achieve health equity,
systematic and increased utilization
inclusion death;
cents, regardless of age; sex; socioecoetetic Association that
strong the
andof improve
evaluation
to achieve trition assistance programs,
disparities,
in nate and
racial diversity, ethnic
and
sustained action is needed for all in
education mentation
all groups; create social nomic status;
of food and nutrition
or
local wellness
health of policies.
ABSTRACT
food and nutrition security
innovative prodiversity, linguistic diversity;
2010;110: that promote
environments
programs,
the American
Diet Assoc.
eliminate food
of and
J Am physical
the position
It is such
indithe United States. To
health status. A safe and adequate
and support
for all; and promote
that 1244-1254.
promote (ADA)
to
are needed,
health
grams
good
Association
physiinterventions
Dietetic
selfinsecurity,
and healthful
food supply promotes optimal
household economic
have a
funding for and
vidual
healthful development
communities
and and
schools
of life.
including adequate
cognitive, social, and emotional uman immunodeficiency virus
cal,
ABSTRACT behaviors across every stage This
of food and nusufficiency.
American
responsibility to provide stuAssociation
shared
of
the NSLP op- (HIV)
increased utilization
Nationwide,
the linchpin growth
(2). Dietetic
is Dietetic
inclusion
is the
STATEMENT
infection is part of social,
position
security
of the
to high-quality,
American
POSITION
Food
(ADA) Position Paper includes
access
basicIt human
dents withccess
thein 2008,
to food is aand
achieved
trition assistance programs, in such
must beDiein over 96,000 schools
erated
bevAssociation
political, and economic struggles
living
American
that
theand
efforts to
ofoptimize
foods
The
nutrihealthful
position
authors’
right.
nutritious
independent review children
It is the
affordable,
the
fundamental
of food and nutrition education
and
improve
need
to
million of the daily
30
to
and
over
States
ser-of the
worldwide. These issues present sigschools
serving
status
programserages. School-based nutrition
that
the United
individualized
in through
literature
Association
in addition to systematic
tetic
residentstional
programs, and innovative
residents.
schools particicitizens and provision
of communities
responsicitizens
In 2008, 81,517
nificant challenges to health care sysmedical
its a
(3).
sharedand
nutrition
of
individual and
therapy,
rehave
assurance
health
review
of security
valuable
including the
ADA’s
vices,
ofconducted using
Eviare its mostSchool
to
promote and support
accesstems
and
Daily
(4).
y. United States
safety
access
SBP
the
the
with
food
in
and
in both the prevention and
nutrition
pated
students
security,
is,
self-sufficienc
National
the
provide and nutrition
dence of
Analysis Process and informeals through
insecurity, that bility to Although
household economic
supply arehealthful
water
through these two
source. Yet, food
andtotal
nutritious
foods
School
education
treatment of HIV infection (1). Acarethe
essential
affordable,
US food
and the access
to
individuals living
the
sysmation
to nutrito high-quality,
ADA Evidence
Lunch Program
position from the
More than 49 million
anothernulimited or intermittent
help provide adequate
tem of foods
cording to the 2008 Report on the
willTopics
health
School-based
importance,
care
are an integral
available
experienced food
programs
to people
beverages.
utmost
Analysis
and
Library.
and acceptable
from the
Breakfast Program,
Assoin the United States
inadequate, safe,program.
proviAmerican
theDietetic
nutrition oftionally
with human
and may positively
Global
of the
immunodeficiency
AIDS Epidemic (2), the prevaincluding
virus
nourishment
services,
Evidence
the total education
acceptable
tritionpaper
part
arehealthful
(7). Analysis Library of
insecurity in 2008. Negative outcomes
issues
accessed in socially
foods
National
en- infection
(HIV)
thethose
lence of HIV appears to have leveled
focuses
promote
throughout
through
of ofciation
the development
theoncontinmeals
clearly
fluence
delineated.
wellness policies
sion
millions
The
use
of
in
an
of
evand non–nutrition-related food Strong
paper
theat �1% of the global population.
in- ways (1), continues
ofoff
and the
uumStates
nutrition
of School
A summary
care. Broad-based
with
Program
(4,5).
enhance
efforts toposition
Lunch another
habits
Likewise,
imidence-based
eating
approach
provides
vironments that across
im- Nutrifothe United
have been associated
Association
an inDietetic
de- health
are
households
of New annual infections have declined
prove
Program,
access
indicators
students tooutcomes
adolescents, and
American
and
of care
and to
treatment
the
Breakfast
portant
and help
added benefits
School
components
earlier reintegrity In
security in children,
malnutrition,
light of the negative
1. 3 million in 2001 to 2.7 million
academic (2).
have stabilized
education
world
in Figure
behaviors.
totalhunger,
HIVof
from
onthe
prevalence
levels
is available
view methods.
in propart
lifelong healthy
The major
tegral cuses
tion Integrity
advantage
velop
the life course,
adults, including substandard
acrossthe
(8).
key food insecurity
pro2004
policies
many parts
insecurity
intake of ADA
of the
world
in 1946, inthe
wellness
2007. By the end of 2007, an estifoodand
led to longer
and
Strong
of the approach
psyinception
actively supported
gram.
is the
more rigorous
From its
impairments,
achievement, inadequate
focuses on dophysical
for including2010
paper
enhance
survivalmote
that
Nutrition
for people
position
living
Child and
mated 33 million people were living
increased riskand
as a bipartiwith HIV
This
infecstandardization
environments
viewed
proposed suffering,
review
hasofbeen
criteria,
sociofamilial
to
nutrients, poor health,
and relatesNSLP
insecurity
tion.
helpis-students
chological which determines
disease, poor
and HIV infection, including 2 miland
foodand
clinical
integrity
social
mestic
which san
minimizes
of federal,ofstate,with
shortnutrition
the likelihood
andConfounding
reauthorization
partnership
and development of chronic poor psychoaccess, rather
(3), it is unwise
and food
be- such
behaviors.
ADA sues,
healthy
medication
bud- children younger than age 15
and
availability
lion
interactions,
reviewer
cofood lifelong
bias
develop
nutrition policy.
(6).
and increases
to as
yet avoidschool disturbances
theHowever,
ease
or
governments
serious,
disease management,
local
a bioterrorism
to allow this Guidelines
morbidities, wasting,
safety from
lipodystrophy,
functioning. Regyears and more than 15 million
food
with
than food
and higher
which
that the Dietary issue
disparate
1980s
articles
lieves sighted
continue.
may
of the early
logical and cognitive
Throughget cuts
healthserve to
standpoint.
the
asinsecurity,
able, public
aging,
disaster
dietetic techniand other
related
women.
alshould
conbe
Other trends include the innatural
compared.
to
1990s
the
For
a
Americans
in
detailed
for
descripapproach
standards
istered dietitians and
insecurity
a broad-based
term foodtion of nutritional
the manditions
Using
further
play key roles
complicate
food and nutrition
disease
creased percentage of new infections
out the paper,
for all
operathe
INTRODUCTION
used in the When
insecufoundation
eviof methods
food
cians, registered, can
local programs.
address
all aspects
tered
y and
apand are systematicall
to refer
agement.
de- analysis,
should
been
used
hasofto
in women, declining numbers of verdence
will beunderstanding
integrity
to greater
access
utrition
ADA’s Eviassistance programs
the revenue
1
willorhelpWith
exceeded
in ending food insecurity valuable
Figure
States
costs
tional
United
insecurity.
the
in and beverages sold
of Analysis Process
the mechanisms
nutrition
rityfoods
make
of HIV
and
and its level
tical
guaranteed
dence
food
“a
as disease
lo-infections from mother to child,
and fined
at http://
ply to all
state, and
uniquely positioned to
food security
terms.that
available from federal,
community
relevant
impact on
body function,
provision of comduring the school
development
that assures
and declining death rates. Overall,
adaeal.com/eaprocess/.
of
summarizes
to students
performance
servedensure
The Comcontributions through
and cash collections,
security.
nutrition policies
are
in cal funding
new
treatments,
lead towellness
nutrition educarangesavailable
of
thedifConclusion
beverages
number of people living with HIV
Statements
andwider
of thefoodsand
day. Local
as-up the
prehensive food and
make
Initiative
took steps toare
Security
pracfor all affected,
schools
populations
legislation
munity
are consistent
management
federal
signed
by Food
has continued to grow, which can be
children
grade by an expertnutrition
for the
has
mandated
work
profestion; competent and collaborative
PAPERa
of Agriculture
POSITION
(7). School
in schools
THE
ference
for
of chronic
relatedalltoschool
FOR
Department
HIV
infection
US
participating
continues
Guidelines
research
to
begroup
RATIONALE
districts
largely
based
Dietary
on
attributed
the
systematic
the
to population exanalywith
of
insecurity
tice; innovative
food
US
struggle with a “trilemma”
of cutting
come more
with
Program.
and sustainLunch
the goal
and when
combined sis
demanding.
School
UPDATE
and sionals
evaluation
pansion and the life-prolonging effects
and
of the supporting
andcomplex
the National
accessing a safe, secure,
creation
the United
solve. These threeofprob2015 through
in- Americans,
inresearch
Achievement
problems
nutrition
of food
half by
advocacy efforts
security
and nutrition
physical
support
food
secu- activity,
evidence. toGrade
policies
antiretroviral therapies (ARTs).
education,
These in
I�Good;
build
Achieving
nutrition
able food supply; and
the
the nutritional
of partnerships
and na- expansion
school
ritythat
to improving
and management
involve
lems
nutrition-reGrade II�Fair;
school environment,
is paramount
The consequences of the HIV panGrademeeting
III�Limited;
tegrity, including a healthy
States of
and a healthful
hunger
at the local, state, regional,
reduce
residents.
systems and
of the meal, minimizing
lated complications of to
and
integrity
learning
HIV
requirements
local foodNutrition
its citizens
Grade
re- and
enhanced
IV�Expert
of infection
demic
Opinion
environment.
Only; and
health
contributes
tional levels.
of Health
the
maintaininginclude a high risk for debilitapaper
US Department
main
eat-(16),
nutrition
significant Since
costs (including
challenges
position
healthful
(4). The
for clients
program
coordinating
Grade
2006
V�Not
of lifelong,
the
Assignable
tion and mortality among adults duralso requires
(becausemaximizing
development
People
J Am Diet Assoc. 2010;110:
Healthy
the isUnited
Services’
fundof there
with
HIV infection
and
Human
facilities),
and security
status
health
and and
promotion
care
pro- integrity
nooutdated
(1). Nutrition
evidence to
ing their most productive years (3).
support orand
education
refute participafood
ing habits”
1368-1377.
preventable
identified
documented,
and
fessionals.
local
outcomes.
Registered
further
initiative
strong
dietitians
acceptability
program
2010 on
been
and diethe conclusion).
student
Particularly in more vulnerable deing research
States hasthrough
can be enhanced
established
of food Evidence-based inforthreats
tetic
dietetic
estimates
technicians,
create
andand
help
recent
should
that
US health
intedietitians
mation for
this(8).
policies
and other topics can be
the most
veloping countries, this leads to a lack
Registered
of registered,
with
wellness
years
andtheir
the
oftion
short at
other
These
andgrate
increase quality
efforts into
the overall
health to fall
goals toregistered,
have taken creativeof steps
continuing
found
environments.
www.adaevidencelibrary.
POSITION STATEMENT
school
technicians,
sustainable infrastructure for eduinsecurity
healthy
health
of
Die- healthful
(94% Schools
to eliminate
andessential
higher
care for
American credentialed
strategies to optimize
lifeare
National
2010
the objective
try to meetcation,
clinical
staff,
with
com and
People
subscriptions
coupledtheir
control costs
forand
nonmemto
food insecurity, economic inpoliciesHealthy
It is the position of the
nutritionthesocial
and
of and
to influence
secure)
Oneschools
andare (2,5).
(5). in
systematic nutrition
be foodbers
(NSLP)
for population
and promote
people
livingwill
with
disparities
integrity
Program
available
Lunch
forstandards
purchase at
stability, and lack of access to health
is US
School
tetic Association that
nation
furthe infection.
havenutritional
to achieve related
HIV
studies
(SBP),
have
objectives formanageProgram
www.adaevidencelibrary.com/store.
in policy-making,
Breakfast
addition, several
perform
care
School In
services, which in turn contribsustained action is needed for all
good nutrition. Many schools
94%]
in
security
g of nutrition
foodcommunityJ Am [to
Diet Assoc.are
of nutrition
“increaseand
cfm.
our understandin
education,
the foundation
ment, to
from full-time to part-time
thered
utes to increased risk for malnutriwhich 2010;110:
food and nutrition security
switched
of
in so doing
and
outcomes
school
households
can sup-related
healthy 1105-1119.
US A
by schools,
roles.
among
offered
non–nutrition
building
purchasing cooperatives,
servicesand
tion. Children are hard-hit by the
In its draft form
(4). achieved
all labor, joined
goals of overweight
can be
foods.
reduce hunger”
insecurity, including
environment
foodeducational
porta the
and
food used more convenienceHIV/acquired immunodeficiency synenvisions
that
2020
school
Diof
People
reinforced
American
funding
and
the
Healthy
adequate
mize nutritional
obesity,
In addition,
through(6),
status
schools.and
emphasized
drome (AIDS) pandemic worldwide
indi- increased
POSITION
long,
schoolsthrough
0002-8223/$36.00
liveSTATEMENT
all people
impleposition Some
which
through
“society inand
Association’s (ADA’s) vidualized
medical nutrition
to boost
etetic of
andrevetherapy,
the growing numbers of orphans
participation
doi: 10.1016/j.jada.2010.07.015meals programs
student
It is the position
theand
American
and of
DieFood
Adolescent
makassurance
by
Child
food
and
on
secu- tend to be malnourished, uneducated,
boosted revenue
tetic Association
nues; othersnutrition
thatPrograms
efforts tostates
a safe
opti-Dietetic
Association
that
rity,
and nutrition
education
Nutrition
more
and live in poverty.
es- appealing
foodsare
© 2010 by the American
ing healthful
sentialbeto the total system preparation
and adequate food supply should
0002-8223/$36.00
In the United States, prevalence
DIETETIC ASSOCIATION
when changing of health methods
adolesavailable to people with human rates increased between 2003
1368 Journal of the AMERICAN
accessible to all children andcare
0002-8223/$36.00
doi: 10.1016/j.jada.2010.06.014
and
immunodeficiency virus infection 2006 as the result of improved
doi: 10.1016/j.jada.2010.05.020
surthroughout the continuum of care.
vival and efforts to encourage testing
Association
© 2010 by the American Dietetic
H
A
N
1244
Journal of the AMERICAN DIETETIC ASSOCIATION
© 2010 by the American Dietetic Association
Journal of the AMERICAN DIETETIC ASSOCIATION
1105
What is the rationale for producing both position
papers and practice papers?
ADA’s decision to produce papers in two formats, a position
paper format and a practice paper format, resulted from an
ADA Association Positions Committee (APC) analysis. The
analysis included input from current authors of ADA position
papers, an ADA member survey on the usefulness of position
papers, and an investigation of position papers produced
by seven other health professional associations. Over 500
ADA members responded to the survey on position paper
format. Analysis results indicated that a brief position paper
that provides a succinct statement and a rationale for ADA
positions would be useful for ADA staff, especially those based
in Washington, DC; ADA members; and other professionals. The
analysis also suggested that practice papers would be useful
to guide the practice of current and future registered dietitians
and dietetic technicians, registered.
For more information about
ADA position and practice papers,
contact APC staff manager,
by phone: 312/899-4892 or
e-mail: ppapers@eatright.org.