Dietary Policies and Programs: Moving Beyond Efficacy and Into "Real-World" Settings.

Stella S Yi,Chau Trinh-Shevrin,Matthew Lee,Yan Li,Simona C Kwon,Rienna Russo

doi:10.1089/heq.2020.0050

Abstract

Purpose: Dietary behaviors are key modifiable risk factors in averting cardiovascular disease (CVD), the leading cause of morbidity, mortality, and disability in the United States. Before investing in adoption and implementation, community-based organizations, public health practitioners, and policymakers—often working with limited resources—need to compare the population health impacts of different food policies and programs to determine priorities, build capacity, and maximize resources. Numerous reports, reviews, and policy briefs have synthesized across evidence-based policies and programs to make recommendations, but few have made a deep acknowledgment that dietary policies and programs are not implemented in a vacuum, and that “real-world” settings are complex, multifaceted and dynamic.Methods: A narrative review was conducted of currently recommended evidence-based approaches to improving dietary behaviors, to describe and characterize applied and practical factors for consideration when adopting and implementing these dietary policies and programs across diverse settings.Results: From the narrative review, six key considerations emerged to guide community-based organizations, public health practitioners, and policymakers on moving from the evidence base, toward implementation in local and community settings.Conclusions: Considerations of “real-world” contextual factors are necessary and important when adopting and selecting evidence-based policies and programs to improve dietary behaviors and ultimately improve CVD outcomes. Promising approaches include those that apply community-partnered research and systems science to examine the equitable implementation of evidence-based dietary policies and programs.

Highlights

Dietary behaviors are key modifiable risk factors in averting cardiovascular disease (CVD), a leading cause of morbidity and mortality in the United States.[1,2,3] Despite global, national, and local initiatives to promote healthy dietary behaviors, building and sustaining healthy diets remain a difficult, perplexing health challenge
Reviews, and policy briefs have synthesized across evidence-based policies and programs to make recommendations, but few have made a deep acknowledgment that dietary policies and programs are not implemented in a vacuum, and that ‘‘real-world’’ settings are complex, multifaceted and dynamic
Twenty-five described approaches Eight Groupings: overarching approaches, multifaceted interventions, community-based nutrition interventions, make healthy foods more affordable, prioritize investment in local agriculture and procurement of local food products, promote healthy foods and beverages, increasing consumer education around eating, preparing and purchasing healthy foods, reduce exposure to unhealthy foods, beverages and eating practices Three-category rating system for evidence: B Supportive evidence—policies and programs supported by at least one systematic review or at least two experimental studies or two quasi-experimental studies with matched concurrent comparisons B Emerging evidence—supported by no more than one experimental or quasi-experimental study with a matched concurrent comparison B Recommended by experts in the field of population health and chronic disease prevention

Summary

Introduction

Dietary behaviors are key modifiable risk factors in averting cardiovascular disease (CVD), a leading cause of morbidity and mortality in the United States.[1,2,3] Despite global, national, and local initiatives to promote healthy dietary behaviors, building and sustaining healthy diets remain a difficult, perplexing health challenge. Most people do not meet, and are far from meeting recommended dietary guidelines. Evidence suggests modest or no changes in food consumption patterns in recent decades.[4,5]. Before investing in adoption and implementation, community-based organizations, public health practitioners, and policymakers—often working with limited resources—need to compare the health impact of different dietary policies and programs to determine priorities and maximize impact. Numerous works have synthesized across evidence-based policies and programs to a Stella S.

Objectives

Findings

Discussion

Conclusion