Opinion: Diet, Disease and Disability: Stop Ignoring the FactsUpdated April 10, 2020 Social Security Disability
A multi-generational approach to nutritional education would help decrease the risk and high cost of life-threatening diseases. Here’s how to implement it.
There’s a health crisis lurking in the bushes of our playgrounds, homes, schools, and neighborhoods. It peeks out every once in awhile and gets our fleeting attention but then we become distracted and ignore it, hoping it will go away. But it is not disappearing on its own and in fact, continues to gain acceptance of Americans until we are now at the point where more than 25% of our children and adults are needlessly at risk for disease, disability and premature death.
The danger is called poor nutrition leading to obesity. It is a crisis that has already cost us millions of dollars because of people who are unable to work, have high medical costs for treatments and collect government benefits under Social Security Disability Insurance. But it is also a problem that could be solved with education and motivation if we are truly serious about improving our quality of life and the economic costs of disease and disability.
You don’t have to look too far into the recent past to see how we dealt with a similar health issue, tobacco use. Despite all indications that cigarettes were killing us, it took decades for Americans to quit smoking as the tobacco industry fought desperately against educating people about the consequences. Nutrition is an even more complicated issue than tobacco use as evidenced by the vast and sometimes conflicting information about food, diet and health. And its enemies are legion.
As a researcher, I understand the complexity of food issues that individuals, families, and communities face. I also understand how human nature causes us to rationalize our food choices even if we believe that diet affects our current and future health. As with any complex issue, it can be very easy to ignore the scientific research behind poor nutrition as a major cause of death and disability –especially at the critical moment when you are hungry and looking for something convenient to eat.
However, as an educator, I believe that dramatic change is possible with a comprehensive and compelling public education campaign. Nutrition is one area of science where there is little wiggle room for interpretation, even at a basic level. Study after study states that chronic diseases caused by poor diet and other lifestyle factors are the leading causes of illness, disability, and premature death. The World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC), the Global Burden of Disease Study, the American Heart Association (AHA), and hundreds of medical doctors and public health professionals all have come to the same conclusion without any hint of disagreement: a diet rich in fruits and vegetables, nuts and seeds, and whole grains as well as low in sodium can unequivocally decrease the risk factors for death and disability. It can hardly be a clearer message than that.
This statement means for you and everyone you know and care about (no matter how many grandmas or grandpas you’ve heard about who eat all the salty foods, fatty meats, and processed snacks yet live to be 100), there is not much chance that you can ignore this fact and avoid disease and disability in mid- to later life. That is, if you even make it to that point.
Of course, there are genetic and environmental factors that influence a person’s propensity to have heart disease, stroke, high blood pressure, and diabetes. But again, the vast collection of health statistics and close examination of decades of scientific research conclude that nutrition is a major, influential factor of health. For example, a disease such as diabetes Type 2 is attributed to diet and a sedentary lifestyle. Until 2001, Diabetes Type 2 was primarily a disease of people over 40. But today it affects 30% more children and adolescents with that number growing every year. Diabetes occurs when your body cannot break down food into energy and is a direct result of diet and inactivity, lifestyle habits that everyone is capable of changing. That is, if everyone truly believed that extending their life by at least 8 years and adding many more years of life without disease or disability were possible (as the research points out). If this information has been well established by science, why aren’t more people convinced to change?
We might learn a lesson from the tobacco habits tackled in the 1990s. At that point, scientific research had definitively attributed smoking as a leading cause of disease, disability, and death. Studies and data analysis showed that smoking cost millions of dollars in health care costs, years of pain and suffering from debilitating diseases, and premature death. With an influx of money from successful lawsuits against tobacco companies, substantial public and private resources were devoted to anti-smoking education for all ages through media and school-based programs. The education included personal health stories and campaigns against the tobacco industry combined with integrated education programs targeted at kids and parents of young children. Of course, there were also laws enacted to prevent smoking in public places and tax increases on tobacco products that played a role in reducing smoking. These efforts dramatically cut smoking rates by almost half among adults plus an even greater and lasting decline among the next generation of potential smokers and those most likely to be affected by disease and disability in the future–adolescents.
Could similar resources devoted to nutrition education motivate more people to improve their diet? Would it be worth our efforts to launch an all-out media and education campaign to help people understand the science of nutrition-caused disease and disability? If so, what might that look like and what kinds of return should we expect?
Preventing disease and disability is a national issue. If we want to reduce our collective spending in the US (now nearly $9 billion a year in disability payouts, more than $193 billion in health care costs associated with heart disease and stroke, not to mention the billions in loss of taxes because people cannot work due to illness and disability) and increase our prospects for more of us to live productive, disease-free lives, there needs to be a carefully planned emphasis on teaching people about this problem, including effective solutions. It means the following:
- Physicians and other health care workers need to add and emphasize nutrition counseling in their repertoire of recommendations to patients, especially during pediatric and adolescent visits but also for those exhibiting the beginning signs of preventable diseases. Information in waiting rooms and patient examination rooms should capitalize on a captive audience for nutrition education in an entertaining yet factual basis. My own doctor has this message highlighted in each of the exam rooms, “If you want to stay out of here, put your fork down!” While that may sound a bit extreme, it is the perfect introduction to a conversation about nutrition, no matter what your reason for being there might be. Few medical schools offer the recommended hours of nutrition education as part of the curriculum. But some schools are changing this by adding courses that teach the student doctors about nutrition, healthy lifestyle and self-care skills while they are in training to imbed these practices and experiences into their personal lives. The more emphasis there is on nutrition education during medical school and training, the more likely it is that doctors graduate with an expanded foundation of knowledge and respect for including this as a common part of their practice.
- School-based programs must be integrated into the curriculum by teachers thoroughly trained in providing effective instruction. Most of us can identify a subject in school that became our favorite because of a teacher who knew just how to motivate us to become excited about the material. The subjects with connections to nutrition are ones that are already taught in school, such as reading, writing, mathematics, science, history, geography, economics and health. The wealth of information already available by nutrition researchers can easily be incorporated into lessons in these subjects through innovative curriculum and instructional strategies that engage students. We have to move beyond a simple pyramid or plate composition as the only mention of nutrition at school. Parent education as a component of school curriculum also strengthens the school-to-home connection and the application of nutrition knowledge to lifelong habits, another important discovery by educational research. Departments of education and health at the state levels as well as school district leaders at the local levels need to embrace nutrition education as a priority. And of course, the federal government has much to gain by supporting such programs as a way of reducing significant costs for Social Security and health-related programs.
- A clearinghouse for web resources should be established to coordinate and evaluate the billion websites with nutrition information. The US government alone has published dietary advice for more than a hundred years creating a tremendous amount of information to try to sift through (many prefaced with this warning: “Historic, archived document. Do not assume content reflects current scientific knowledge, policies or practices”). In addition to the millions of government and health-related sources are the hundreds of physicians, dietitians and health advocates producing videos, newsletters, books, blogs, podcasts and articles promoting their particular interpretation or emphasis on what people should do to improve their diets. Tools and strategies for assessing nutrition information would be powerful.
- Food producers and manufacturers market their products using altered facts to make their products sound healthy even if they are not (“Gluten-free” the package states on foods that never contain gluten. Claims of “Lower Sodium” are on products where a 10% cut in sodium has been made but the product still has high amounts.). How does anyone know which information to trust? This is where knowledgeable reviewers, those with credentials and expertise, need to step up to the plate and provide input. If Rotten Tomatoes, Amazon, and every retail outlet in the world figured out how to evaluate and influence consumer behavior, why couldn’t this same strategy work for nutrition information about specific products?
- Media campaigns created to closely link with education programs in nutrition can make a big impact. Depending on your social circle, you may already be bombarded with recipes, photos of food about to be consumed, and testimonials about diet on social media. A successful campaign includes food producers, chefs, medical professionals, scientists, and yes, even your friends and family. A coordinated, effective message can encompass all of these viewpoints if it connects to science-based, research outcomes with persuasive, targeted calls to action.
- Enlist seniors, their service providers, and advocates to take a leading role. Since almost half of the people with disabilities are 65 and over, the effects of nutrition on them are immense. As a director of a busy, highly-rated rehabilitation facility explained to me, “When you are ill or disabled, nutrition is a critical component of improving your health and rehabilitation. When we increased our attention and expenditures on quality nutrition, our recovery and well-being rates increased accordingly.” Not only can the stories and experiences of seniors, especially those with disabilities, educate and motivate others, but this growing population group has a vested interest in the health of their offspring and the general health of our nation’s current and potential workforce. The American Society on Aging, the Center for Advocacy for the Rights and Interests of the Elderly, the National Academy on an Aging Society, AARP and many other advocacy and senior care groups need to offer their resources to this important cause that is integral to their population as well as to everyone connected to them.
These are just a few examples of ideas that have been proven to work effectively in previous campaigns related to improving health and other national concerns. The evidence points to them being successful in improving the nutrition of our nation.
While there are many different experts telling us how best to improve nutrition, they all emphatically support people learning more about it and then taking action to choose their food carefully.
How many more decades of worldwide scientific evidence will it take to make individuals take notice and “eat to live” instead of “live to eat?” We need to commit immediately to making a difference in our individual and collective quality of life. It is a matter of harnessing the research, teaching it effectively and making it a priority to promote healthy eating and the prevention of unnecessary disease and disability for millions of Americans. It’s time to drag that monster out of the bushes and into the light of today.
-- Jackie Booth, Ph.D.