Nutrition Trends Implications for Diabetes Health Care Professionals

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					                                          Nutrition FYI

Nutrition Trends: Implications for Diabetes Health Care
Carrie S. Swift, MS, RD, BC-ADM, CDE

Since 1991, the American Dietetic       sex, age-groups, and education                healthy diet because they report that
Association has conducted nation-       levels. The majority of respondents           they are satisfied with the way they
wide consumer nutrition trend           in all groups considered exercise and         eat, and they do not want to give up
surveys (1991, 1995, 1997, 2000,        physical activity “very important.”           their favorite foods. The association
2002, and 2008). Results from the           In each survey since 1991, the            states that “People like what they eat
2008 survey were presented at the       American Dietetic Association has             . . . and eat what they like.”
association’s 2008 annual meeting,      segmented participants into three                  The major or minor reasons to
the Food & Nutrition Conference         consumer groups representative                not do more to change eating habits
and Expo, in October 2008 in            of their overall attitudes toward             included:
Chicago. Each of the six surveys        maintaining a healthy diet and get-           •	 “I’m satisfied with the way I eat.”
conducted to date was designed          ting regular exercise. The groups                  (79%)
to “measure people’s attitudes,         are labeled “I’m already doing                •	 “I don’t want to give up the foods
knowledge, beliefs, and behaviors       it”(describing consumers who are                   I like.” (73%)
regarding food and nutrition; and to    concerned about nutrition and over-           •	 “It takes too much time to keep
identify trends and understand how      all fitness who feel they are doing                track of my diet.” (54%)
consumers’ attitudes and behavior       all they can to eat a healthy diet),          •	 “I need more practical tips to help
have evolved over time.”1               “I know I should” (consumers who                   me eat right.” (52%)
    From 25 February through 7          indicate importance but may not               •	 “I don’t know or understand
March 2008, the telephone survey,       have taken significant action to eat a             guidelines for diet and nutrition.”
~ 18 minutes in length, was carried     healthy diet), and “Don’t bother me”               (41%)
out in a representative sample of the   (consumers who do not feel that diet
U.S. adult population (n = 783).1       and exercise are important to them            Food Consumption, Knowledge, and
The assumed standard deviation for      and are the least concerned with              Beliefs
each question is ± 3%, and results      nutrition and their overall fitness.          Respondents were also asked about
were projected to the 90% confi-            The 2008 survey ranking of the            their intake of certain foods and
dence interval.1 Public information     consumer groups compared to the               nutrients and whether their con-
releases and a PowerPoint presenta-     2002 results are as follows:                  sumption had increased, decreased,
tion with details regarding the 2008    •	 “I’m already doing it”: 43% (up            or stayed the same during the past 5
survey can be found at the associa-                                                   years. Overall, the top five foods that
                                            from 38% in 2002)
tion’s website (                                                     survey participants reported they
                                        •	 “I know I should”: 38% (up from
trends2008).                                                                          had increased and the percentage of
                                            30% in 2002)
                                                                                      respondents reporting an increase
                                        •	 “Don’t bother me”: 19% (down
Importance of Diet, Nutrition, and                                                    were:
                                            from 32% in 2002)
Physical Activity                                                                     •	 Whole grains (56%)
When asked about the importance of      The association reports that the “I’m         •	 Vegetables (50%)
diet, nutrition, and physical activ-    already doing it” group has increased         •	 Fruits (48%)
ity, approximately three out of five    steadily in each survey, representing         •	 Low-fat foods (48%)
consumer respondents answered that      movement away from the “Don’t                 •	 Fish (43%)
diet, nutrition, and physical activ-    bother me” group.
ity are “very important” to them                                                      When broken down by age-group,
personally; women and people with       Top Reasons for Not Eating Better             adults aged 18–34 years were the
college or post-graduate degrees were   The survey explored reasons why               most likely to have increased their
more likely to say that nutrition and   people are not doing more to improve          consumption of fruits, vegetables,
diet are “very important.” Less vari-   their eating habits. It found that >          and whole grains. Those ≥ 65 years
ation was observed in exercise and      70% of adults do not do more to               of age were the least likely to have
physical activity importance among      achieve balanced nutrition and a              increased consumption of these
                                        Diabetes Spectrum Volume 22, Number 1, 2009                                              23
                                                 Nutrition FYI

                                                                                             ble” sources of nutrition information
                                                                                             and the percentages of respondents
                                                                                             reporting this were:
                   T.V.                                                                      •	 RD (78%)
                                                                                             •	 Nutritionist (78%)
                                                                                             •	 Doctor (61%)
           Magazines                                                                         •	 Nurse (57%)
                                                                                             •	 U.S. Department of Agriculture/
                                                                                                My Pyramid Program (46%)
                                                                                             •	 References/books (43%)
              Internet                                                                       •	 School (39%)
                                                                                             •	 Personal trainer (39%)
                                                                                             •	 Package labels (35%)
          Newspapers                                                                         •	 Health club/gym (29%)

                                                                                             Implications for Diabetes Health
                                                                                             Care Professionals
       Family/Friends                                                                        According to the survey, an increas-
                                                                                             ing number of adults in the United
                                                                                             States are conscious of nutrition
                          0%        20%            40%            60%              80%       and exercise and are taking steps to
                                                                                             eat more healthfully and engage in
     Figure 1. Top five sources of nutrition information in 2008. 2                          regular physical activity. This is good
     foods. More than half of the respon-      food and nutrition information from           news for diabetes health care profes-
     dents reported no change in their         television and magazines (Figure 1).          sionals. Positive lifestyle changes,
     consumption of dairy foods, pork,         However, the most popular sources             including meal planning and physical
     low-carbohydrate foods, omega-3           are not necessarily considered the            activity, aid in improving diabe-
     fatty acids, low-sodium foods, and        most credible sources of nutrition            tes control and promoting healthy
     alternative sweeteners. By a large        information by survey participants.           weight.3
     margin, foods containing trans fats           Although television remains the                More than 24 million Americans
     were the most likely to have reduced      top source of nutrition and food              have diabetes, and many more are
     consumption during the past 5             information at 63%, it is down from           at risk.4 The challenge for diabetes
     years. An average of 56% of all           72% in 2002. Magazines have also              health care professionals is to assist
     participants reported cutting back        declined from 58% in 2002 to 45%              people with diabetes in moving from
     on these foods. Forty-one percent         in the current survey. In 2008, 24%           the “I know I should” category to
     reported a decreased intake of beef,      of participants named the Internet            the “I am already doing it” group.
     33% cut back on pork, and 23%             as a source of nutrition and food             To facilitate this behavior change,
     reduced dairy intake. Less than 20%       information. This figure surpassed            it is important to encourage regu-
     of respondents had decreased their        that for newspapers and is nearly             lar physical activity and healthful
     consumption of alternative sweeten-       double the number of people who               food choices at each encounter with
     ers and low-carbohydrate products.        identified the Internet as a source in        patients or clients.
         More than three in four respon-       2002. Reports of using the Internet                At times, it can be a daunting task
     dents had heard “a lot” about             as a source for nutrition informa-            to share all the information needed
     health-related effects of low-fat         tion vary widely among age-groups:            to successfully manage diabetes in
     foods, and 72% had heard about            42% of those aged 25–34 years use             a meaningful way. As a result, the
     foods containing trans fats.              the Internet, while only 5% of those          message of physical activity may
     Additionally, 94% of those surveyed       ≥ 65 years of age use the Internet to         be minimized or left out entirely.
     said that they believe whole-grain        find nutrition information.                   Potential benefits of regular exer-
     bread is healthier than white bread.          In addition to identifying where          cise are many, including improved
     More than half of the respondents         they get their nutrition information,         blood glucose control, reduction of
     believed that organically grown           participants were asked to read a list        cardiovascular risk factors, promo-
     fruits and vegetables are healthier       of sources and rate the credibility           tion of weight loss, and an enhanced
     than conventionally grown, 38%            of each. At 78%, registered dieti-            sense of well-being.5 It is generally
     believed there was no difference, and     tians (RDs) and nutritionists topped          accepted to recommend ~ 150 min-
     8% believed conventionally grown          the “very credible” list. Eight-six           utes of moderate-intensity exercise
     produce was healthier.                    percent of participants have heard            per week for people with diabetes.5
                                               of RDs. By a three-to-one margin,                  People with diabetes, like those
     Sources of Food and Nutrition             respondents indicated that there is           in the general population, are
     Information                               a difference between an RD and a              encouraged to choose a variety of
     The nutrition trends survey indicates     nutritionist. The top 10 “very credi-         fiber-containing foods, including
     that Americans get most of their                                                        whole grains, legumes, fruits, and
24                                             Diabetes Spectrum Volume 22, Number 1, 2009
                                            Nutrition FYI

vegetables.3 More than half of the        ful eating and regular exercise into          References
respondents had increased their           practical action steps so that the            1
                                                                                         American Dietetic Association: Summary
intake of whole-grain foods, and          information may be used in a ben-             of findings: American Dietetic Association’s
approximately half had increased          eficial way. Traditional methods of           public opinion survey Nutrition and You:
their fruit and vegetable intake.                                                       Trends 2008 [article online]. Available from
                                          communicating these messages are    
Continuing to promote the favorable       face-to-face with clients in groups or        Findings_ADA_Trends_2008.pdf
message of increasing consumption
                                          individual sessions. Combining the            2
                                                                                         American Dietetic Association: Nutrition
of these foods is beneficial for people
with diabetes.                            public’s most popular nutrition infor-        and You: Trends 2008: report of results
                                          mation sources with the credibility           [article online]. Available from http://www.
    The nutrition trends survey                                               
also reported that respondents had        of diabetes health care professionals         You_2008_Web.pdf
decreased their intake of foods           can extend the reach of the message           3
                                                                                         American Diabetes Association: Nutrition
containing trans fats and increased       beyond traditional settings.                  recommendations and interventions for dia-
their consumption of low-fat foods,           Although being interviewed for            betes [Position Statement]. Diabetes Care 31
the same nutrition messages that                                                        (Suppl. 1):S61–S78, 2008
                                          the media or writing for consumer
they reported they had heard “a           print articles may seem overwhelm-
                                                                                         American Diabetes Association: Economic
lot” about. This indicates that the                                                     costs of diabetes in the U.S. in 2007. Diabetes
                                          ing, the message from these activities        Care 31:596–615, 2008
messages are being heard, and con-        can make a difference. Television
sumers are responding. For people
                                                                                         American Diabetes Association: Standards of
                                          and magazines remain the most                 medical care in diabetes [Position Statement].
with diabetes, the primary goal with      common sources of nutrition infor-            Diabetes Care 31 (Suppl. 1):S12–S54, 2008
respect to dietary fat remains limit-
                                          mation, with the Internet gaining
ing intake of saturated fatty acids,
trans fatty acids, and cholesterol to     in popularity. Diabetes health care           Carrie S. Swift, MS, RD, BC-ADM,
reduce the risk for cardiovascular        professionals are encouraged to pro-          CDE, is the dietetics coordinator for
disease.3                                 mote positive, credible nutrition and         the Department of Veterans Affairs
    Diabetes health care profession-      physical activity messages through            Medical Center in Walla Walla,
als can assist people with diabetes       these popular information sources to          Wash. She is an associate editor of
by translating the science of health-     reach more people with diabetes.              Diabetes Spectrum.

                                          Diabetes Spectrum Volume 22, Number 1, 2009                                                     25

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