Nutrition education an important element of disease prevention

American public often confused about healthy eating habits

Healthy eating is a good target area for education, because people are confused about what healthy eating means, contends Andrea Giancoli, MPH, RD, an American Dietetic Association spokesperson who lives in Southern California.

The American public lacks good, basic nutrition knowledge. As a result, people are unable to sort out the misinformation passed along by any entity ranging from the media to their next door neighbor.

Misconceptions about healthy eating are always changing, depending on what is being marketed, she says. For a long time, people stopped eating carbohydrates, thinking they were unhealthy. Yet it is the quality of a carbohydrate that determines the nutritional value of the food, for some are nutrient-dense, says Giancoli.

For example, often people take a lot of food supplements thinking they are practicing healthy behavior, yet people should obtain the right nutrients from the food eaten, she says. "Multivitamins and supplements have taken on the quality of being necessary as part of the diet, and food has taken a back seat. People think in order to be healthy, they need to take supplements, and that is not the case at all," says Giancoli.

Manuel Villacorta, MS, RD, CSSD, an American Dietetic Association spokesperson in San Francisco and author of a weight loss program called Eating Free, says that generally people know that sugary and high-fat foods are not good for them. However, often they think a healthy food can be eaten in unlimited quantities. Many of his clients, for example, will think nothing of using a quarter cup of olive oil to cook food, because they know it is a heart-healthy fat. People are often told what foods are good to eat and which are bad, yet they are not told how much they should eat. Portion size is an important part of education.

"Our portion sizes are on steroids," says Villacorta.

Both Villacorta and Giancoli agree that people not only need much more than information, they also need to understand how to put it into practice. For example, people need to see a realistic meal to understand portions.

"You really have to show people what food looks like on a plate," says Giancoli.

Another area for education is the definition of a plant-based diet and how to implement it, she says. There should be more emphasis on eating fruits, vegetables, nuts, beans, and whole grains — with meat a smaller component on the plate. Meat also should no longer be the main entrée, Giancoli explains.

Learning to interpret food labels and the terms on packaging should also be a focus in education. Multi-grain bread is not always the healthiest choice if enriched wheat flour is the first ingredient on the label, rather than whole wheat flour. Enriched means the flour has been refined, and some of the nutrients have been added back, says Giancoli.

"People need to understand the terms on labels. They need to look at the label and understand the ingredient list and what the nutrition back panel means to them," she explains.

Food preparation needs to be a part of nutrition education, says Villacorta. In his private practice, he finds many of his clients are not preparing their meals from fresh product, but instead eating a lot of processed food, which frequently leads to weight gain. People need to allow time to shop and cook and get back into the kitchen. He adds that people once ate out to celebrate a special occasion, and eating in was the norm. Now, it is the opposite, and often people eat several meals from restaurants during the day.

Make lessons personal

Ideally, education about healthy eating should be individualized, according to Giancoli. The problem with a generic diet approach is that people are complex and have various reasons for their dietary and lifestyle behaviors; therefore, it is good to conduct an individual assessment, she adds.

The assessment should include viewing lab work to see such health risks as high cholesterol, determining a person's body mass index (BMI), and his or her regular, daily diet. Another important element of the assessment is determining the person's relationship to food. It's important to know when people eat, why they eat, what time of day they eat, and what is going on in their life, explains Giancoli. For example, is the person juggling two jobs; is he or she home all day and bored; does the person have access to healthy food and the money to purchase it?

"We must assess each person individually and base the plan on their individual needs, so assessment is critical. If you give people a piece of paper without knowing anything about them, you miss an opportunity for a teachable moment," says Giancoli.

People have different cultural points of view, likes and dislikes, routines, and schedules that affect how they eat, says Villacorta. Also, it is important to look at the obstacles to a healthy diet, he adds.

He had a client who was 50 pounds overweight, but was having trouble eating healthy meals, because he was on the road most of the day working as a salesman. Together, they looked at the obstacles and worked out a plan that included packing an ice chest with yogurt, fruit, and sandwiches.

Also, Villacorta asked for a menu from each of the restaurants the man frequented and picked the best options, so he would know what to order. "We had to come up with a plan he was willing to do," says Villacorta.

It is important to assess what the patient is willing to do, he adds.

Registered dietitians are trying to use the motivational interviewing technique, i.e., where a patient comes up with a plan vs. being told what to do, says Giancoli.

"We educate them, give them skills-based learning, and then have the patients come up with the changes they will make; and we come to a mutual agreement," she says.

While health care facilities cannot always work closely with patients when providing nutrition education, they can tell them how to get an individual consult with a registered dietitian, says Giancoli. The Chicago-based American Dietetic Association has a section on its website (eatright.org) that provides a list of registered dietitians that people can find in their region by entering a zip code.

There are many reasons to consult with a registered dietitian for help with an eating plan, she adds. These might include: health problems such as diabetes, cardiovascular disease, or high blood pressure; digestive problems; weight gain or loss; sports performance improvement; and food allergies. Sometimes people are just interested in healthy eating and want to learn more about navigating all the food options.

"Overall, a dietitian's job is to figure out a person's current situation, where he or she wants to be, and the steps to an improved diet," explains Giancoli.

With obesity on the rise in the United States — along with the health problems associated with it — nutrition literacy is one of the factors that must be addressed to help reverse the trend. Yet it is only one piece of the pie, says Giancoli. Another piece is the amount of food marketing that goes on in the United States, pushing people to eat foods that are not the healthiest choices. A third piece is sedentary behavior. It is very easy for many people to do almost everything, including their jobs during the workday; therefore, the activities of daily living don't require much energy.

Another piece of a healthy diet is the affordability and accessibility of healthy foods.

"There are many factors at play contributing to the obesity epidemic," says Giancoli.

She adds that reaching the public with nutrition education is a goal that can be addressed with a multitude of teaching methods.

Hospitals can offer healthy living classes, healthy cooking classes, and nutrition 101 classes. A sign might be placed on the elevator reminding people to take the stairs and telling them how many calories they would burn climbing one flight. Hospitals might book their dietitian on talk radio, create a TV ad, place messages in grocery stores and other public places, or post daily nutrition tips or healthy recipes on Facebook.

Also, every hospital could have a nutrition Twitter feed or create a mobile phone app. Giancoli suggests an app that would allow a person in a restaurant to assess the meal he or she is about to eat by taking a photo of it. There are similar applications already created, she says, so if a hospital doesn't have the funding to create an app, staff could connect patients with apps that are already available.

One thing people must always be told is that nutrition and physical exercise are a marriage, says Giancoli. Optimum health is achieved by both healthy eating and engaging in physical activity, she explains.

Sources

• Andrea Giancoli, MPH, RD, American Dietetic Association Spokesperson. Telephone: (310) 344-6548 (cell). E-mail: Giancoli_RD@yahoo.com.

• Manuel Villacorta, MS, RD, CSSD, American Dietetic Association Spokesperson. Telephone: (415) 398-2102. E-mail: manuel@manuelvillacorta.com.