Implementing Dietary Recommendations for Heart Health: Moving from Ideal to Real April 28, 2010 Presenters: James M. Rippe, MD – Leading cardiologist, Founder and Director, Rippe Lifestyle Institute Lisa Cooper, MS, RD – Senior Research Dietitian, Rippe Lifestyle Institute Moderator: Barbara J. Ivens, MS, RD, FADA – Senior Nutrition Director, ConAgra Foods SELECT SUMMARY SLIDES FOR DEVELOPING STAND ALONE PRESENTATIONS

Nutri-Bites sm Webinar Summary  Current landscape of authoritative recommendations for heart health converging on the need for a preventative approach.  Understanding influences on, and barriers to, heart healthy eating provides opportunities for developing effective strategies to help individuals make recommendations ‘real’ in their everyday lives.  Individualize the interventions; use Vital Signs of Cardiovascular Health to open counseling conversation; target those most receptive to dietary changes for heart health. Implementing Dietary Recommendations for Heart Health: Moving from Ideal to Real

Prevention: THE Focus of Future Guidelines Nutrition and dietary patterns play a major role in the promotion of health and prevention of disease. Diet is not “one factor but a complex constellation of multiple factors.” These facts and observations of how they play out in lives of Americans are shaping new goals, guidelines and strategies for change.

A Welcome Step Lifestyle medicine practitioners and research scientists have promoted for over two decades Lifestyle medicine practitioners and research scientists have promoted for over two decades Part of the objectives of Dietary Guidelines for Americans Part of the objectives of Dietary Guidelines for Americans An objective of 2008 Guidelines for Physical Activity An objective of 2008 Guidelines for Physical Activity The approach of professional organizations such as the The approach of professional organizations such as the American Dietetic Association ( American Dietetic Association ( Preventive Cardiovascular Nurses Association ( and others have championed Preventive Cardiovascular Nurses Association ( and others have championedwww.pcna.net This approach to prevention is well-established.

Basics of Human Food Behaviors Convenience Convenience Variety and choice Variety and choice (The option of) Value (The option of) Value Food taste or palatability also plays an important role in food choices. Research suggests that there are three principles of human behavior that cannot be changed. These relate to food choices and other choices. As individuals and consumers we seek: Sources: Brian Wansink. Marketing Nutrition: Soy, Functional Foods, Biotechnology and Obesity. Urbana and Chicago: University of Illinois Press, pp ) Dr. Wansink’s presentation to DGAC

Many Influences on Food Choices Beyond internal determinants of food behaviors, a growing body of research suggests that a complex mix of environmental factors influence individual food choices. Better understanding of these factors may help us: Answer why nutritional guidelines have not had as great an impact on individual food choices and public health as intended and hoped. Answer why nutritional guidelines have not had as great an impact on individual food choices and public health as intended and hoped. Develop more effective strategies  how  to promote individual and population change and adherence to healthful food choices and eating patterns. Develop more effective strategies  how  to promote individual and population change and adherence to healthful food choices and eating patterns.

Hierarchy of Factors that Influence Food Choice Adapted from AHA Scientific Statement: Implementing American Heart Association Pediatric and Adult Nutrition Guidelines. Circulation 2009;119:

Guidelines Continue Evolving... Moving from nutrients and components to emphasize whole foods and eating patterns Moving from nutrients and components to emphasize whole foods and eating patterns Providing simple messages about food Providing simple messages about food –Eat more fruits, vegetables and whole grains –Get two fish meals weekly; eat healthy fats –Limit sodium Positive messages when possible – Positive messages when possible – “Do” rather than “Don’t” “Do” rather than “Don’t” Linking nutrition and physical activity Linking nutrition and physical activity to Meet the Challenges

Strategies for Change Start with the individual client (or focused group) Start with the individual client (or focused group) Assess client readiness to change Assess client readiness to change Assess barriers that may block success Assess barriers that may block success Use counseling techniques that foster clients making their own decisions and choosing steps for change Use counseling techniques that foster clients making their own decisions and choosing steps for change –Motivational interviewing –Five A’s: Assess, Advise, Agree, Assist, Arrange Provide tools for change Provide tools for change Provide support Provide support Goal: Empower client  self efficacy What do we know works? Giddings et al. Circulation 2009; Martins & McNeil. CliinPsychRev 2009; Searight, AmFamPhys 2009; Henson et al. Appetite 2010

Vital Signs of Heart Healthy Diet – AHA Healthy Diet Score Vital Signs of Heart Healthy Diet – AHA Healthy Diet Score Vital Signs of Obesity Vital Signs of Obesity Vital Signs of Physical Activity Vital Signs of Physical Activity Use Vital Signs of Heart Health Taking each vital sign provides a cost-effective opportunity to discuss heart healthy behaviors and strategies for change. Fruits and vegetables  4.5 cups/day Fish  two 3.5 oz svgs/wk (preferably oily fish) Fiber rich whole grains  three 1 oz. equiv/day Sodium <1500 mg/day Sugar-sweetened beverages  450 cal (36 oz)/wk [1/4 of a week’s discretionary cal.]  Weight  BMI  Waist circumference  Stanford Brief Activity Survey (SBAS) or other brief, validated checklist kcal/day basis

Resource Links on Implementing Heart Health Recommendations  American Heart Association  Vital Signs of Heart Healthy Diet - Lloyd-Jones et al. Defining and Setting National Goals for Cardiovascular Health Promotion and Disease Reduction. Circulation 2010; epub Jan 10, 2010, Abstract.Abstract  Vital Signs of Obesity - de Koning L et al. Eur Heart J Apr;28(7): Epub 2007 Abstract; Craigie AM et al. Obes Facts. 2009;2(3): Abstract; Dunkley AJ et al. Obes. Facts 2009, Abstract; Ness-Abramof R, Apovian CM. Nutr Clin Pract Aug-Sep;23(4): , Abstract; Lemieux I, et al. Can J Cardiol Oct;23 Suppl B:23B-31B Abstract; Schneider HJ et al. J Clin Endocrinol Metab 2010, Abstract.Abstract  Vital Signs of Physical Activity - Pate et al. AJLM 2010 Abstract; Dunn AL. AJLM 2009 Abstract; Taylor-Piliae et al. J Cardio Rehabil Prev 2007, Abstract; Taylor-Piliae et al. J Phys Act Health. 2010, Abstract.Abstract

Original recording of April 28, 2010 webinar and PDF download of PowerPoint available at:  Implementing Dietary Recommendations for Heart Health: Moving from Ideal to Real