1. 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

2. Our “practice environment” …

3. Controversy → Competition

4. Where do people get their nutrition advice?

5. 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

6. 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.

7. 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

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

9. 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

10. 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

11. 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.

12. 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.

13. Selected Nutrition and Body Weight Objectives from HP 2020

14. 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% %–14% %–19% %–24% %–29% ≥30%
Bottom line: Despite our best efforts, the epidemic continues…

15. 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

16. Nutrient Basics Human body & food Same materials
Different arrangements

17. 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

18. 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?

19. 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

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

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

22. A Way to Judge Which Foods Are Most Nutritious

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

24. 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

25. Stages of Behavior Change

26. Sorting the Imposters from the Real Nutrition Experts
Controversy 1

27. 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

28. 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

29. Earmarks of Nutrition Quackery

30. 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

31. Credible Source of Nutrition Information
American Dietetic Association
National Council Against Health Fraud
American Council on Science and health

32. 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?

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

34. True Nutrition Experts
Credentials
Accredited institution
Licensing

35. 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 )

36. http://www. leg. state. fl. us/Statutes/index. cfm

37. 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.

38.  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.

39. “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.

40. “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.

41.  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.

42. 468.505 Exemptions; exceptions.
Those licensed in Chapters , 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

43. 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.

44. 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.