HUN 4296 Nutrition & Health Issues Week 1 Day 1 Part 1 Foundations to sort Facts from Fads Based on Chapter 1: Nutrition: Concepts & Controversies, 12e Sizer/Whitney

Our “practice environment” …

Controversy → Competition

Where do people get their nutrition advice?

What makes nutrition a fertile field for controversy? Nutrition Science Active, changing, and growing body of knowledge The scientific approach Systematic , methodical, slow Scientific challenges Paradigm shifts to respected theories Evidence-based v Practice-based

What’s at stake? Four of the top 10 causes of death are directly related to nutrition. Accidents are related to drinking alcohol. Bottom line: the Standard American Diet is killing us.

Lifelong impact of nutrition Chosen foods have a cumulative effect Your body continuously renews itself Best foods Support your body’s growth & maintenance No “good” or “bad” foods – depends on circumstance and individual Malnutrition Deficiencies, imbalances, and excesses

Genetics and Individuality Genetics and nutrition affect diseases to varying degrees Human genome DNA

Impact of genetics Genetics play a role in 9 of the 10 leading causes of death, including: Cancer Heart disease Stroke Diabetes Alzheimer’s disease

National Nutrition Surveillance National Health and Nutrition Examination Surveys (NHANES) Recording of health status and intake Behavioral Risk Factor Surveillance System (BRFSS) Telephone survey of adults 18 y.o. and older Continuing Survey of Food Intakes by Individuals (CSFII) What people eat for two days Comparing foods eaten with recommendations

Our national health agenda: The evolution of Healthy People 2020 Target Year 1990 2000 2010 2020 Overarching Goals Decrease mortality: infants–adults Increase independence among older adults Increase span of healthy life Reduce health disparities Achieve access to preventive services for all Increase quality and years of healthy life Eliminate health disparities Attain high-quality, longer lives free of preventable disease Achieve health equity; eliminate disparities Create social and physical environments that promote good health Promote quality of life, healthy development, healthy behaviors across life stages # Topic Areas 15 22 28 39* # Objectives/ Measures 226/NA 312/NA 467/1,000 >580/1200 * With objectives The number of objectives has increased with each decade. Healthy People 1990 set forth 226 objectives, Healthy People 2000 included 312 objectives, Healthy People 2010 identified 467 objectives with 1,000 measures, and Healthy People 2020 has nearly 600 objectives with 1,200 measures.

This graphic visually depicts the ecological and determinants approach that Healthy People 2020 takes in framing the national health objectives. The concept of determinants describes how the conditions in which we live and work, such our physical and social environments and access to health services, as well as our individual behavior and biology, can have an enormous impact on our health. The graphic framework attempts to illustrate the fundamental degree of overlap among the determinants of health, as well as emphasize their collective impact and influence on health outcomes and conditions. The framework also underscores a continued focus on population disparities, including those categorized by race/ethnicity, socioeconomic status, gender, age, disability status, sexual orientation, and geographic location.

Selected Nutrition and Body Weight Objectives from HP 2020

Obesity Trends* Among U.S. Adults BRFSS, 1990, 2000, 2010 (*BMI 30, or about 30 lbs. overweight for 5’4” person) 1990 2000 2010 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Bottom line: Despite our best efforts, the epidemic continues…

Reviewing the basics… Your body uses energy that comes indirectly from the sun Six kinds of nutrients Four are organic (contain carbon) Three provide energy

Nutrient Basics Human body & food Same materials Different arrangements

Nutrient Basics Energy-yielding nutrients Vitamins and minerals Carbohydrates – 4 cal/g Fats – 9 cal/g Proteins – 4 cal/g Vitamins and minerals Provide no energy Some are essential Scientists calculate needs

Quiz! The 20 oz. “Activator” from Smoothie King has 1g Fat 105 g CHO 19g Pro How many total calories? How many calories would it be if you drank only 16 oz? If you had 3 CHO / starch exchanges, how much could you drink? Under what circumstances would this be a good choice to drink?

Can I Live on Just Supplements? Elemental diets Administered to severely ill people “Real food” is superior to supplements Nutrient interactions Phytochemicals Physical contributions Psychological contributions

The Abundance of Foods to Choose From Whole foods Typical consumption Fruits Vegetables Types of foods Fast, processed, functional, staple

Recognizing a Nutritious Diet Five characteristics Adequacy Balance Calorie control Intakes should not exceed need Moderation Not abstinence Variety

A Way to Judge Which Foods Are Most Nutritious

Knowledge is not enough Factors influencing food-related choices Traditional and ethnic foods Convenience Physical factors Psychological factors Social factors Philosophical factors

A Guide for Behavior Change Behavior change takes substantial effort Six stages of change Assessment and goals Realistic goals Obstacles to change Competence Confidence Motivation

Stages of Behavior Change

Sorting the Imposters from the Real Nutrition Experts Controversy 1

Can I Trust the Media to Deliver Nutrition News? Training of news media Sensationalism Be a trend watcher Read news with an educated eye Published in peer-reviewed journal Description of research methods & subjects Findings presented in context of previous research

Information Sources & Costs of Wrong Choices Quackery Sources of nutrition information Television and magazines Nutrition-related products and services Billions in customer dollars Identifying quackery

Earmarks of Nutrition Quackery

Identifying Valid Nutrition Information Characteristics of scientific research Properly designed scientific experiments Inadequacy of anecdotal evidence Animal findings applied to humans Careful with generalizations Report of findings in scientific journals

Credible Source of Nutrition Information American Dietetic Association www.eatright.org National Council Against Health Fraud www.ncahf.org American Council on Science and health www.acsh.org

Nutrition on the Net Judging website credibility Who is responsible for the site? Do the names and credentials of information providers appear? Are links with other reliable information sites provided? Is the site updated regularly? Is the site selling a product or service? Does the site charge a fee to gain access?

True Nutrition Experts American Dietetic Association (ADA) Registered dietitian (RD) Certified diabetes educator Public health nutritionist Dietetic technician Dietetic technician registered

True Nutrition Experts Credentials Accredited institution Licensing

Dietetics and Nutrition Practice Act Title XXXII REGULATION OF PROFESSIONS AND OCCUPATIONS Chapter 468 MISCELLANEOUS PROFESSIONS AND OCCUPATIONS PART X DIETETICS AND NUTRITION PRACTICE (ss. 468.501-468.518)

http://www. leg. state. fl. us/Statutes/index. cfm http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0468/0468PARTXContentsIndex.html

468.502 Purpose and intent The Legislature finds that: the practice of dietetics and nutrition or nutrition counseling by unskilled and incompetent practitioners presents a danger to the public health and safety. it is difficult for the public to make informed choices about dietitians and nutritionists the consequences of wrong choices could seriously endanger the public health and safety. The sole legislative purpose in enacting this part is to ensure that every person who practices dietetics and nutrition or nutrition counseling in this state meets minimum requirements for safe practice.

468.503 Definitions “Dietetics” means the integration and application of the principles derived from the sciences of nutrition, biochemistry, food, physiology, and management and from the behavioral and social sciences to achieve and maintain a person’s health throughout the person’s life. It is an integral part of preventive, diagnostic, curative, and restorative health care of individuals, groups, or both.

“Dietetics and nutrition practice”… …shall include assessing nutrition needs and status using appropriate data; recommending appropriate dietary regimens, nutrition support, and nutrient intake; improving health status through nutrition research, counseling, and education; and developing, implementing, and managing nutrition care systems, which includes, but is not limited to, evaluating, modifying, and maintaining appropriate standards of high quality in food and nutrition care services.

“Nutrition assessment” means the evaluation of the nutrition needs of individuals or groups, using appropriate data to determine nutrient needs or status and make appropriate nutrition recommendations. (9) “Nutrition counseling” means advising and assisting individuals or groups on appropriate nutrition intake by integrating information from the nutrition assessment.

468.504 License required No person may engage for remuneration in dietetics and nutrition practice or nutrition counseling or hold himself or herself out as a practitioner of dietetics and nutrition practice or nutrition counseling unless the person is licensed in accordance with the provisions of this part.

468.505 Exemptions; exceptions. Those licensed in Chapters 457-466, 480, 490, or 491 and rendering services within the scope of their practice Persons employed in government, cooperative extension home economist, a student or trainee under supervision, someone from out of state taking a course of study… an educator in the employ of a not-for-profit,, employed by a hospital, nursing home, assisted living facility, or is a dietetic technician

Also exempted: g) A person who markets or distributes food, food materials, or dietary supplements, or any person who engages in the explanation of the use and benefits of those products or the preparation of those products, if that person does not engage for a fee in dietetics and nutrition practice or nutrition counseling. (j) Any person who provides weight control services or related weight control products, provided the program has been reviewed by, consultation is available from, and no program change can be initiated without prior approval by a licensed dietitian/nutritionist, a dietitian or nutritionist licensed in another state that has licensure requirements considered by the council to be at least as stringent as the requirements for licensure under this part, or a registered dietitian.

468.516 Practice requirements.— A licensee under this part shall not implement a dietary plan for a condition for which the patient is under the active care of a physician licensed under chapter 458 or chapter 459, without the oral or written dietary order of the referring physician. In the event the licensee is unable to obtain authorization or consultation after a good faith effort to obtain it from the physician, the licensee may use professional discretion in providing nutrition services until authorization or consultation is obtained from the physician.