Communicating Nutrition Information to Influence Consumer Behavior: Closing the gap between recommendations and behavior July 18, 2013 Presenter: Jeanne P. Goldberg, PhD, RD Professor of Nutrition, Friedman School of Nutrition Science and Public Policy, Tufts University Moderator: James M. Rippe, MD – Leading cardiologist, Founder and Director, Rippe Lifestyle Institute Approved for 1 CPE (Level 2) by the Commission on Dietetic Registration, credentialing agency for the Academy of Nutrition and Dietetics. NUTRI-BITES ® Webinar Series Original recording of the July 18, 2013 webinar and PDF download of presentation available at:

Communicating Nutrition Information to Influence Consumer Behavior This webinar:  Described the current role of nutrition communication within the context of individual eating behavior  Explained how our understanding of the role of communication in changing eating behavior is evolving  Identified opportunities to improve the effectiveness of communication to influence individual behavior to improve eating behaviors 2 NUTRI-BITES ® Webinar Series

Environmental Barriers The food environment is referred to by some as “toxic” More moderate statement of the issue: food is widely available and what is available does not always represent the best choices. Food is relatively cheap; foods that are recommended tend to be more expensive than highly processed foods that contain lots of sugars and fats. Portions in restaurants are too big. Fast food restaurants typically promote larger portions. In some areas, healthier options are not available: the problem of “food deserts.”

THE DIET AND CARDIOVASCULAR DISEASE CONNECTION: A case study of the communication challenge

Challenges to behavior change: the complexity of the information Dietary Guidelines 1980: “avoid too much fat, saturated fat, and cholesterol”

To the consumer : A nutrition literacy challenge “Avoid too much” fat, saturated fat, and cholesterol The language of the specific guidance raises further questions: How much is “too much?” What is saturated fat? What is cholesterol? How much is “too much?” What is saturated fat? What is cholesterol? What does “moderate your use of...” mean? What does “limit your intake of butter, cream, hydrogenated margarines…” mean? Read labels carefully to determine both amounts and types of fat contained in foods. What does “moderate your use of...” mean? What does “limit your intake of butter, cream, hydrogenated margarines…” mean? Read labels carefully to determine both amounts and types of fat contained in foods.

Fat Guideline 2005 Less than 10% of calories from saturated fat; less than 300 mg of cholesterol; trans fats as low as possible Total fat 20-35% of calories; most from polyunsaturated and monounsaturated fats Choose meat, poultry, dry beans, and dairy foods that are lean, low-fat, or fat-free Limit fats and oils high in saturated and/or trans fatty acids and choose products low in these fats and oils How many calories a day do I consume? How do I calculate cholesterol? What are mono and polyunsaturated fats? What are saturated and trans fats?

Consumer understanding of the 2000 Guidelines Respondents understood that fat is essential but that too much can pose health risks They are confused about healthy vs. unhealthy fats, and which foods contain which There is too much information and it is confusing

The fat guidelines 2010 Eat less advice: Consume less than 10% of calories from saturated fatty acids. Consume less than 300 mg per day of dietary cholesterol. Keep trans fatty acid consumption as low as possible, especially by limiting foods that contain synthetic sources of trans fats, such as partially hydrogenated oils, and by limiting other solid fats. Reduce the intake of calories from solid fats and added sugars. Eat more advice: Replace protein foods that are higher in solid fats with choices that are lower in solid fats and calories and/or are sources of oils. Use oils to replace solid fats where possible.

How well do Americans understand the Dietary Guidelines in 2013? % of Americans have seen the MyPlate graphic* Increasing awareness of DGA % of Americans heard of them % of Americans heard of them Awareness hasn’t translated into behavior change Since 2000 and 2005 DGA were issued, fruit consumption declined and vegetable consumption is unchanged ** Recent data found that average consumers meet the DGA only about 7 days per year (2% of the time)*** IFIC, 2013* FDA, CDC, via Watts et al, 2010** Rowe et al, 2011***

What do Americans actually eat? Food GroupsUSDA Food PatternUsual U.S. Adult Intake Vegetables (all)2.5 cups1.6 cups * Fruit and juices2.0 cups1.0 cup * Grains – total6.0 ounces6.4 ounces Whole grains  3.0 ounces 0.6 ounces* Milk and milk products3.0 cups1.5 cups * Protein foods Meat1.8 ounces2.5 ounces Poultry1.5 ounces1.2 ounces Eggs0.4 ounces Fish/seafood1.2 ounces0.5 ounces* Nuts, seeds, soy0.6 ounces0.5 ounces Oils27 grams18 grams* Solid fats16 grams43 grams* Added sugars32 grams79 grams * AlcoholND9.9 grams Dietary Guidelines for Americans, 2010

Understand your audience – there is no generic “consumer” Develop simple actionable strategies and messages – use your client pool to help develop them. Help your audience develop the food related skills that will allow them to shop and cook cost-effectively and efficiently. Know the changing marketplace Identify misconceptions Address confusions Help your audience develop the food related skills that will allow them to shop and cook cost-effectively and efficiently. Know the changing marketplace Identify misconceptions Address confusions Accept the fact that change occurs slowly and that positive reinforcement goes a long way toward making progress. Too often we say “yes, but.” The message will go further with “Yes, that is great. Now let’s move on to the next step.” Accept the fact that change occurs slowly and that positive reinforcement goes a long way toward making progress. Too often we say “yes, but.” The message will go further with “Yes, that is great. Now let’s move on to the next step.” How can we close the gap?

Americans’ dietary fat consumption: let’s applaud the progress NHANES II, Ernst et al, AJCN 1997* Kuklina et al, NCHS 2013** 1990 Dietary Guidelines are first to quantify recommendations for total fat and saturated fat intake  30% of total calories from fat <10% of total calories from saturated fat 1990 Dietary Guidelines are first to quantify recommendations for total fat and saturated fat intake  30% of total calories from fat <10% of total calories from saturated fat Mean intakes* 1980 – 42% total calories from fat 2010 – 33% total calories from fat Percentage of Americans meeting guidelines for saturated fat intake** 1980 – 25% 2010 – 42%

The glass is… The ½ empty glass view: Taken so long and we’ve achieved so little The ½ empty glass view: Taken so long and we’ve achieved so little The ½ full glass view: Managed to accomplish some real, measurable shifts in behavior in the face of an environment that isn’t especially conducive to healthy eating The ½ full glass view: Managed to accomplish some real, measurable shifts in behavior in the face of an environment that isn’t especially conducive to healthy eating …half full.