Dietary Goals Research Articles

American Body: Fitness and the Commodification of Exercise

American Body:Fitness and the Commodification of Exercise Sarah Schrank (bio) GETTING PHYSICAL: The Rise of Fitness Culture in America. By Shelly McKenzie. Lawrence: University Press of Kansas. 2013. MAKING THE AMERICAN BODY: The Remarkable Saga of the Men and Women Whose Feats, Feuds, and Passions Shaped Fitness History. By Jonathan Black. Lincoln and London: University of Nebraska Press. 2013. There are few, if any, places in the United States today where fitness is not a major pursuit. Whether Americans are actually engaged in arduous regimens for rapid weight loss or training for taxing contests of human endurance is almost beside the point. Fitness has become part of our built environment as gyms, martial arts, yoga, Pilates, and cross-training facilities, and their brightly-lit signs, are now cornerstones of strip malls, gentrified downtowns, and the “lifestyle centers” that mix commercial and residential use. The reflective tape of running shoes glinting in one’s headlights is a familiar feature of night driving. [End Page 23] Television, whether traditional network channels or new streaming services like Hulu, relentlessly advertises weight-loss products, fitness training programs, and celebrity exercise DVDs. Smartphones carry apps that allow us to track our fitness progress while national political discourse is periodically marked by support for, or outrage against, organic vegetables in public school lunch programs, calorie listings on franchise menus, and restricting the size of the Big Gulp. Meanwhile an “obesity epidemic” is the tagline on many a news story and a source of concern among feminist critics who worry that such increased surveillance and medicalization of the body is a sanctioned way to “fat” shame and reify sexist, racist, and class hierarchies.1 American attitudes toward the regulation of food and diet are complicated and political but they generally boil down to whether or not fitness is a private or a public concern. While the books under review here point out that today’s obsessive interest in fitness is nothing new, I would suggest that its intensifying significance on the national cultural and political stage is closely related to contemporary debates over healthcare and whether or not access to modern medicine is a privilege of status or a right of citizenry. As such, the American body plays a bigger role in the body politic than ever before. Meanwhile, there is surprisingly little medical consensus on what fitness actually means. Is it having a body mass index (BMI) that falls within accepted norms? Is it living a long life? Is it being free of major disease? Does it mean being able to run one mile or twenty? Is fitness the same as having visible muscle tone? Does it simply mean being happy? What is the difference between fitness and health? What is “wellness”? Debates rage throughout the medical community and even a cursory search through the major academic American medical journals will show little agreement between kinesiology, nutritional science, neuroscience, clinical psychology, biology, gastrointestinal science, internal medicine, or any of the myriad subfields contained within, as to what a general definition of fitness is or what our dietary goals should be. Should we be eating fat or not? Will gluten melt our brains? Should our raw vegetable intake be 40 percent or 90 percent of our diet? Is twenty minutes of cardiovascular exercise every day enough? Or is ninety minutes three times a week adequate? It quickly becomes clear how a charismatic personality with a spectacular six-pack and a media-friendly face—who offers a step-by-step, pay-as-you-go training program to the better body that equates a better life—can attract millions of Americans with access to credit. It is much easier to buy the promise of fitness and happiness than to figure it out on your own and is preferable to not doing anything at all. There are obvious reasons why fitness is consistently a multibillion-dollar industry in the United States. And yet it is also remarkably capricious; the megastar of exercise infomercials today may overnight find him or herself tossed on the fitness dust heap alongside a million unwanted Tae Bo videos. In Making the American Body: The Remarkable Saga of the Men and Women Whose Feats, Feuds...

Advocating for Reduced Sugar Consumption to Reduce the Prevalence of Noncommunicable Diseases

Over the recent decades, non-communicable diseases (NCDs) have emerged as the leading killer worldwide. The recent estimates released by the World Health Organization suggested that on an annual basis close to 40 million people succumb to the NCDs and their associated complications. The World Health Organization (WHO), strongly advocates that all adults and children should reduce their daily intake of free sugars to less than 10% of their total energy intake. As heterogeneous settings are prevalent across the world, the primary challenge is to combine these recommendations with the existing nutrient guidelines and dietary goals, in such a manner that these healthy practices percolate till the remote sections of community. In conclusion, it is the need of the hour to not only seriously consider but even incorporate the recommendations of the World Health Organization in policies so that the future epidemic of non-communicable diseases can be prevented.

Role of vitamins in the tentative dietary goal for preventing life-style-related diseases

Role of vitamins in the tentative dietary goal for preventing life-style-related diseases

Improvement in diet habits, independent of physical activity helps to reduce incident diabetes among prediabetic Asian Indian men

AimsTo assess the beneficial effects of the components of lifestyle intervention in reducing incidence of diabetes in Asian Indian men with impaired glucose tolerance (IGT) in India. MethodsThis analysis was based on a 2 year prospective, randomized controlled primary prevention trial in a cohort of Asian Indian men with IGT (n=537) (Clinical Trial No: NCT00819455). Intervention and control groups were given standard care advice at baseline. Additionally, the intervention group received frequent, mobile phone based text message reminders on healthy lifestyle principles. Dietary intake and physical activity habits were recorded by validated questionnaires. The lifestyle goals were: reductions in consumption of carbohydrates, oil, portion size and body mass index of at least 1 unit (1kg/m2) from baseline and maintenance of good physical activity. The association between diabetes and lifestyle goals achieved was assessed using multiple logistic regression analyses. Changes in insulin sensitivity (Matsuda's insulin sensitivity index) and oral disposition index during the follow-up were assessed. ResultsAt the end of the study, 123 (23.8%) participants developed diabetes. The mean lifestyle score was higher in the intervention group compared with control (2.59±1.13 vs. 2.28±1.17; P=0.002). Among the 5 lifestyle variables, significant improvements in the 3 dietary goal were seen with intervention. Concomitant improvement in insulin sensitivity and oral disposition index was noted. Higher lifestyle score was associated with lower risk of developing diabetes (odds ratio: 0.54 [95% CI: 0.44–0.70]; P<0.0001). ConclusionsBeneficial effects of intervention were associated with increased compliance to lifestyle goals. The plausible mechanism is through improvement in insulin sensitivity and beta cell preservation.

Nutrition Troubles

This conversation is part of a special issue on “Critical Nutrition” in which multiple authors weigh in on various themes related to the origins, character, and consequences of contemporary American nutrition discourses and practices, as well as how nutrition might be known and done differently. In this section one author calls into question the validity and efficacy of the 1977 Dietary Goals for the United States that are still widely used in official nutrition information. A second author considers whether official dietary recommendations are commonly known, let alone followed, and therefore questions their effectiveness at shaping actual dietary practice.

Long-term changes in dietary and food intake behaviour in the Diabetes Prevention Program Outcomes Study.

To compare change in dietary intake, with an emphasis on food groups and food intake behaviour, over time across treatment arms in a diabetes prevention trial and to assess the differences in dietary intake among demographic groups within treatment arms. Data are from the Diabetes Prevention Program and Diabetes Prevention Program Outcomes Study. Participants were randomized to a lifestyle intervention (n = 1079), metformin (n = 1073) or placebo (n = 1082) for an average of 3years, after which the initial results regarding the benefits of the lifestyle intervention were released and all participants were offered a modified lifestyle intervention. Dietary intake was assessed using a food frequency questionnaire at baseline and at 1, 5, 6 and 9years after randomization. Compared with the metformin and placebo arms, participants in the lifestyle arm maintained a lower total fat and saturated fat and a higher fibre intake up to 9years after randomization and lower intakes of red meat and sweets were maintained for up to 5years. Younger participants had higher intakes of poultry and lower intakes of fruits compared with their older counterparts, particularly in the lifestyle arm. Black participants tended to have lower dairy and higher poultry intakes compared with white and Hispanic participants. In the lifestyle arm, men tended to have higher grain, fruit and fish intakes than women. Changes in nutrient intake among participants in the lifestyle intervention were maintained for up to 9years. Younger participants reported more unhealthy diets over time and thus may benefit from additional support to achieve and maintain dietary goals.

Utility of a New Food Value Analysis Application to Evaluate Trade-offs When Making Food Selections

Consumers face a wide variety of options when selecting foods to feed themselves and their households, and they must balance a host of factors, including cost, preparation time, nutrition, taste, cooking skills, shelf life, food waste, and food safety. Each of these factors adds or subtracts value and helps determine the true cost of a food item based on an individual’s personal value system. If a single variable, such as cost, is examined, it may provide an incomplete picture of the true value of that food. A new Web-based application, Food Value Analysis, permits nutrition educators to evaluate relative costs as well as monitor adherence to dietary recommendations when consumers select one version of a food over another. This analysis demonstrates how the application can be used to compare differences among similar foods of different levels of processing. Nutrition professionals can use the application to help consumers make appropriate trade-offs and reach dietary goals, while accommodating differences in cooking skills as well as time and budgetary constraints.

Dietary Assessment of a School Meal Program in Tanzania

To assess the current meal program for residents at a Tanzanian secondary school and compare it with available nutrition standards. Mixed design with interviews of Tanzanian secondary school cooks (facilitated by a translator) and headmaster; mealtime observations and calculated daily intake of students. Structured questionnaire addressing food purchase and preparation, dietary goals for students, attitudes and emphasis placed on nutrition in the school. Nutrient intake data analyzed using Nutricalc, MyPlate, and Dietary Reference Intake (DRI) goals to estimate students' adequacy of intake compared to macro- and micro-nutrient needs. The meal plan at the Nyegina Secondary School (n=511) consisted of three meals for all students (13-18 years) based on the purchase plan and custom of the school. Interviews and observations determined that students routinely consumed entire meals. Estimated caloric intake, protein, carbohydrates, and dietary fiber met DRI goals along with many vitamins and minerals. However, the following vitamins and minerals fell below the DRI goals with percentages depicting students' low estimated daily nutrient intake: vitamins A (5%), B12 (0%), and D (0%); and minerals calcium (15%), phosphorus (87%), and potassium (63%). For this Tanzanian school-based meal program, recommendations include improving food purchasing patterns, optimizing nutrient timing and resources, and expanding access to nutrition education and standards. Although overall caloric and protein needs appeared to be met, limitations in this meal program could affect these adolescents' learning abilities and contribute to health problems typically seen in developing countries. Encouraging local stakeholders to buy into changes can lead to implementation of recommendations.

Demographic characteristics and food choices of participants in the Special Diabetes Program for American Indians Diabetes Prevention Demonstration Project

Objective. American Indians and Alaska Natives (AI/ANs) suffer a disproportionate burden of diabetes. Identifying food choices of AI/ANs at risk of type 2 diabetes, living in both rural and urban settings, is critical to the development of culturally relevant, evidence-based education strategies designed to reduce morbidity and mortality in this population.Design. At baseline, 3135 AI/AN adults participating in the Special Diabetes Program for American Indians Diabetes Prevention Demonstration Project (SDPI-DP) completed a socio-demographic survey and a 27-item food frequency questionnaire (FFQ). The primary dietary behavior goal of SDPI-DP education sessions and lifestyle coaching is changes in food choices, i.e., increased fruits, vegetables and whole grains, decreased high sugar beverages, red meat, and processed foods. Subsequently, program assessment focuses on changes in food types. Foods were delineated using a ‘healthy’ and ‘unhealthy’ classification as defined by the educators advising participants. Urban and rural differences were examined using χ2 tests and two sample t-tests. Multiple linear regressions and linear mixed models were used to assess the association between socio-demographic factors and food choice.Results. Retired participants, those living in urban areas and with high income and education selected healthy foods most frequently. Young males, those with low income and education consumed unhealthy foods most frequently. Selection of unhealthy foods did not differ by urban and rural setting.Conclusions. The ubiquitous nature of unhealthy food choices makes them hard to avoid. Food choice differences by gender, age, income, and setting suggest that nutrition education should more effectively target and meets the needs of young AI/AN males.

Understanding experiences of participating in a weight loss lifestyle intervention trial: a qualitative evaluation of South Asians at high risk of diabetes

ObjectiveTo explore the reasons for enrolling, experiences of participating and reasons for remaining in a family-based, cluster randomised controlled trial of a dietitian-delivered lifestyle modification intervention aiming to reduce obesity...

Inpatient obesity intervention with postdischarge telephone follow-up: A randomized trial.

Obesity-related comorbidities frequently contribute to acute illness. Obesity interventions during hospitalization are not often utilized but may be effective. To examine whether inpatient weight loss intervention with postdischarge follow-up results in weight loss at 6 months when compared to control. Prospective, randomized controlled trial. Academic medical center in Chicago, Illinois. Obese adult inpatients. Intervention subjects viewed a weight education video, underwent personalized counseling, and set specific weight loss, dietary, and fitness goals prior to discharge. All participants were followed by phone over the subsequent 6 months. The trial was unblinded to participants, physicians, and investigators. Primary outcome was weight change between groups at 6 months. Weight change from baseline and waist-to-hip ratios (WHR) were also assessed. For 176 participants in the intention-to-treat analysis, mean baseline weight for the intervention group was 107.7 kg (standard deviation [SD]=16.7) and 105.1 kg (SD=17.4) for controls. Mean weight loss at 6 months was 1.08 kg (SD=4.33) for intervention subjects and 1.35 kg (SD=3.65) among controls. There was no significant difference in weight loss between groups at 6 months (P=0.26). As-treated analysis yielded similar results. There were no differences in WHRs between the intervention and control at 6 months (0.04 vs 0.04, P=0.59). We found no difference in weight loss between the intervention and control groups at 6 months.

Many college students desire food‐related rewards for short‐term goals to improve diet and physical activity (811.27)

Objective: To assess the desired rewards of college students for short‐term goals to improve diet or physical activity (PA). Methods: College students (n=286) enrolled in a required 10‐week health course at Oregon State University volunteered to participate in the Better Eating Starts Today (B.E.S.T) Project in Corvallis, Oregon. Students completed a required assignment that focused on behavioral changes related to healthier eating or increasing PA. Students set three goals with the following format: specific, measurable, attainable, realistic and timely (S.M.A.R.T). Rewards were divided into those associated with fitness or dietary goals then further divided into 1 of 7 subcategories. Results: Among 858 rewards, 810 were used in this analysis; 48 were excluded because the goal was non‐dietary/PA related or missing data. Sixty‐four percent of the rewards were associated with fitness goals, 36% with dietary goals. Food‐related rewards were most frequent in fitness and dietary goals, 33% and 54%, respectively. Entertainment‐related rewards followed with 19% for fitness goals and 23% for dietary goals. Conclusion: Regardless of short‐term goal, the most desired reward is food‐related. Therefore, educators may need to pay more attention to teach college students to incentivize themselves for health behavior change in creative yet sensible and balanced ways.Grant Funding Source: PacificSource Healthcare

Choosing the best method to estimate the energy density of a population using food purchase data

Energy density (ED) is a measure of the energy content of a food component or diet relative to a standard unit of weight. Widespread variation in ED assessment methodologies exist. The present study aimed to explore the feasibility of calculating the ED of the Scottish diet using UK food purchase survey data and to identify the most appropriate method for calculating ED for use in the development of a Scottish Dietary Goal that captures any socioeconomic differences. Energy density was calculated using five different methods [food; food and milk; food, milk and energy containing (non-alcoholic) beverages; food, milk and all non-alcoholic beverages; and all food and beverages]. ED of the Scottish diet was estimated for each of the ED methods and data were examined by deprivation category. Mean ED varied from 409 to 847 kJ 100 g(-1) depending on the method used. ED values calculated from food (847 kJ 100 g(-1) ) and food and milk (718 kJ 100 g(-1) ) were most comparable to other published data, with the latter being a more accurate reflection of all food consumed. For these two methods, there was a significant gradient between the most and least deprived quintiles (892-807 and 737-696 kJ 100 g(-1) for food and food and milk, respectively). Because the World Cancer Research Fund recommendations are based on ED from food and milk, it was considered prudent to use this method for policy purposes and for future monitoring work of the Scottish Diet to ensure consistency of reporting and comparability with other published studies.

Executive Summary: Heart Disease and Stroke Statistics—2014 Update

Author(s): Go, Alan S; Mozaffarian, Dariush; Roger, Veronique L; Benjamin, Emelia J; Berry, Jarett D; Blaha, Michael J; Dai, Shifan; Ford, Earl S; Fox, Caroline S; Franco, Sheila; Fullerton, Heather J; Gillespie, Cathleen; Hailpern, Susan M; Heit, John A; Howard, Virginia J; Huffman, Mark D; Judd, Suzanne E; Kissela, Brett M; Kittner, Steven J; Lackland, Daniel T; Lichtman, Judith H; Lisabeth, Lynda D; Mackey, Rachel H; Magid, David J; Marcus, Gregory M; Marelli, Ariane; Matchar, David B; McGuire, Darren K; Mohler, Emile R; Moy, Claudia S; Mussolino, Michael E; Neumar, Robert W; Nichol, Graham; Pandey, Dilip K; Paynter, Nina P; Reeves, Matthew J; Sorlie, Paul D; Stein, Joel; Towfighi, Amytis; Turan, Tanya N; Virani, Salim S; Wong, Nathan D; Woo, Daniel; Turner, Melanie B; American Heart Association Statistics Committee and Stroke Statistics Subcommittee

The interaction between dietary and life goals: using goal systems theory to explore healthy diet and life goals

Objective: To examine the types of life and dietary goals individuals report and how these goal domains interact as framed by goal systems theory. Methods: This work is a cross-sectional survey study. Measures included the incidence of common life and dietary goals and how these goals interact with and facilitate each other. Results: The results of a quantitative survey (n = 46 participants), which was informed by two focus groups (n = 17 participants), showed that participants are trying to achieve several different life (e.g. achieving financial success) and dietary goals (e.g. eating more fruits and vegetables, drinking more water, and losing weight) and that these two types of goals interact to both facilitate and conflict with each other. Having a life goal of exercising was significantly associated with healthy eating goals when compared with other life goals (p's < .05), suggesting these goals may be linked and help to facilitate one another. Being in the maintenance phase with the goal of healthy eating was associated with participants feeling like they were more successful in their other non-diet-related health goals (p < .05), suggesting maintenance of goals can facilitate success in achieving other goals. Conclusions: Life goals can have an impact on a person's ability to achieve and maintain dietary and other health goals. Health educators may help to facilitate long-term behavior change by examining a person's life goals as well as dietary goals.

The Impact of a Community Pharmacy-Based Coaching Program on Patient Confidence and Lifestyle

Objective: Like their urban counterparts, rural populations are experiencing increased health risks due to chronic disease. However, disease management is more problematic due to isolation, increased difficulty in getting to medical appointments, and reduced numbers of medical personnel. We undertook a pilot study to investigate the feasibility and utility of health coaching for rural residents with type 2 diabetes mellitus (DM2) from a local pharmacy. Methods: Using the pharmacy database to identify qualified individuals, a nursing student recruited four individuals aged 40 - 79, with a history of DM2 of 3 - 15 years, to participate in the pilot project. Individual in-person interviews were conducted to identify specific goals to effectively self-manage their condition and to rate their confidence in their ability to fulfill these goals. Three monthly sessions were held to review and update goals, and to record blood pressure, waist circumference and weight measurements. Results: At the end of the study, all four achieved success in reaching and maintaining their personal dietary and physical activity goals. Significantly, all participants expressed increased confidence in their ability to self-manage their diabetes after health coaching. Conclusion: The provision of health coaching services from local pharmacies has potential to support rural clients in chronic disease management in medically under-serviced rural areas.

McGovern's Senate Select Committee on Nutrition and Human Needs versus the meat industry on the diet-heart question (1976-1977).

For decades, public health advocates have confronted industry over dietary policy, their debates focusing on how to address evidentiary uncertainty. In 1977, enough consensus existed among epidemiologists that the Senate Select Committee on Nutrition and Human Need used the diet-heart association to perform an extraordinary act: advocate dietary goals for a healthier diet. During its hearings, the meat industry tested that consensus. In one year, the committee produced two editions of its Dietary Goals for the United States, the second containing a conciliatory statement about coronary heart disease and meat consumption. Critics have characterized the revision as a surrender to special interests. But the senators faced issues for which they were professionally unprepared: conflicts within science over the interpretation of data and notions of proof. Ultimately, it was lack of scientific consensus on these factors, not simply political acquiescence, that allowed special interests to secure changes in the guidelines.

Development of exchange lists for Mediterranean and Healthy Eating Diets: implementation in an intervention trial

There has been little research published on the adaptation of diabetic exchange list diet approaches for the design of intervention diets in health research despite their clinical utility. The exchange list approach can provide clear and precise guidance on multiple dietary changes simultaneously. The present study aimed to develop exchange list diets for Mediterranean and Healthy Eating, and to evaluate adherence, dietary intakes and markers of health risks with each counselling approach in 120 subjects at increased risk for developing colon cancer. A randomised clinical trial was implemented in the USA involving telephone counselling. The Mediterranean diet had 10 dietary goals targeting increases in mono-unsaturated fats, n-3 fats, whole grains and the amount and variety of fruits and vegetables. The Healthy Eating diet had five dietary goals that were based on the US Healthy People 2010 recommendations. Dietary compliance was similar in both diet arms, with 82-88% of goals being met at 6 months, although subjects took more time to achieve the Mediterranean goals than the Healthy Eating goals. The relatively modest fruit and vegetable goals in the Healthy Eating arm were exceeded, resulting in fruit and vegetable intakes of approximately eight servings per day in each arm after 6 months. A significant (P < 0.05) weight loss and a decrease in serum C-reactive protein concentrations were observed in the overweight/obese subgroup of subjects in the Mediterranean arm in the absence of weight loss goals. Counselling for the Mediterranean diet may be useful for both improving diet quality and for achieving a modest weight loss in overweight or obese individuals.

Lifestyle interventions reduce cardiovascular risk in patients with coronary artery disease: A randomized clinical trial

Nurse-led interventions have proven beneficial to reduce estimated cardiovascular risk. The purpose of this study was to evaluate the effect of systematic, nurse-led individual lifestyle counseling sessions on the reduction of 10-year cardiovascular risk scores in patients with coronary artery disease (CAD). This was a randomized clinical trial of CAD patients treated at a tertiary referral hospital. The intervention group received nurse-led guidance by means of five face-to-face sessions and telephone contact over the course of one year, starting three months after hospital discharge. Exercise and dietary goals were set for each patient and monitored at each session. The control group received standard medical advice. Patients were stratified by Framingham risk score and compared at the end of the follow-up period. The final sample comprised 74 patients, 38 in the intervention group and 36 in the control group. Mean age was 58 ± 9 years; 74% of patients were male. A 1.7 point (-13.6%) reduction in risk score was recorded in the intervention group, vs a 1.2 point increase in risk score (+11%) in the control group (p=0.011). Significant between-group differences were detected for weight (intervention, 78 ± 14 kg at baseline vs 77 ± 14 kg at study end; control, 78 ± 15 kg vs 79 ± 15 kg; p=0.04), systolic blood pressure (intervention, 136 ± 22 mm Hg vs 124 ± 15 mm Hg; control, 126 ± 15 mm Hg vs 129 ± 16 mm Hg; p=0.005), and diastolic blood pressure (intervention, 82 ± 10 mm Hg vs 77 ± 09 mm Hg; control, 79 ± 09 mm Hg vs 80 ± 10 mm Hg; p=0.02). Structured and systematic nurse-led lifestyle counseling effectively reduced cardiovascular risk score.

Health Canada’s evaluation of the use of glycemic index claims on food labels

The glycemic index (GI) is a system that ranks foods according to the blood glucose-increasing potential of servings of foods that provide the same amount of available carbohydrate. The GI was originally developed as a tool for carbohydrate exchange in the dietary management of glycemia in persons with diabetes, and studies have generally supported modest benefits of low-GI diets in this population. Despite inconsistent results for the utility of the GI in the nondiabetic population, there is some interest in its universal application on food labels to assist consumers in making food choices that would help them meet their dietary goals. The objective of this review was to evaluate the usefulness of including the GI values of foods as part of the information on food labels in Canada. Health Canada's assessment identified 3 areas of concern with respect to GI labeling: 1) the GI measure has poor accuracy and precision for labeling purposes; 2) as a ratio, the GI does not vary in response to the amount of food consumed and the partial replacement of available carbohydrates with unavailable carbohydrates, whereas the glycemic response does; and 3) an unintended focus on the GI for food selection could lead to food choices that are inconsistent with national dietary guidelines. Hence, Health Canada's current opinion is that the inclusion of the GI value on the label of eligible food products would be misleading and would not add value to nutrition labeling and dietary guidelines in assisting consumers to make healthier food choices.