Updated Dietary Guidelines Can Help Patients Change Habits

How many family physicians and/or their patients will actually read the updated 112-page “Dietary Guidelines for Americans, 2010,” wonders American Academy of Family Physicians (AAFP) member and weight management expert Michelle May, MD, of Phoenix, who pointed out that the updated guidelines particularly emphasize the need for Americans to eat a healthier diet and increase their physical activity.

“The dietary guidelines do a good job of laying out what the general recommendations are, but in its current format, [the guidelines are] not going to be helpful to the majority of patients,” May said in a statement released by the AAFP. “We have this lengthy document that the vast majority of Americans will probably never read and probably the vast majority of physicians will never read.”

But with more than one-third of US children and more than two-thirds of adults considered overweight or obese, May thinks family physicians need to help their patients identify relevant steps they can work on in relation to the recommendations, which were outlined in an executive summary.

According to the summary, the guidelines cover 23 key recommendations, including that Americans should:

• reduce daily sodium intake to less than 2,300 mg and further reduce intake to 1,500 mg among persons who are 51 or older and those of any age who are black or have hypertension, diabetes, or chronic kidney disease;
• consume less than 10% of calories from saturated fatty acids by replacing them with monounsaturated and polyunsaturated fatty acids;
• consume less than 300 mg of dietary cholesterol per day;
• consume at least half of all grains as whole grains; and
• consume alcohol in moderation, a maximum of one drink per day for women and two drinks per day for men if alcohol is consumed.

Family physicians should consider counseling patients about nutrition and physical activity as part of their prescription or treatment plan in nearly every patient encounter, said May, whether it be for a physical exam or to follow up on a patient’s chronic disease.

And that approach is in line with the AAFP’s Americans in Motion—Healthy Interventions (AIM-HI), which focuses on improving health by addressing physical activity, nutrition, and emotional well-being, said May.

However, the updated guidelines, which were jointly developed by the USDA and HHS, differ from AIM-HI’s approach in one chief regard—they emphasize monitoring caloric intake.

“With AIM-HI, we steered away from that [monitoring] because people are not going to count calories for the rest of their lives,” said May, adding that the majority of people who struggle with weight issues eat mindlessly or for emotional reasons.

“They’re not making the connection between how they’re using food and its effect on their health and body weight,” she said. “I think the dietary guidelines do little to close that gap, but family physicians can help people key in on some small steps they’re willing to make, focus on those and make an action plan.”

For example, May says a physician could focus on educating a patient with a family history of cardiovascular disease about the recommendations regarding saturated fats, trans fatty acids, and cholesterol. Similarly, a patient with hypertension should be informed about the sodium recommendations and encouraged to take simple steps, such as reading food labels and not salting food at the table.

“Physicians aren’t having these conversations because they’re too busy or don’t feel comfortable with it,” said May. “We can’t just write more prescriptions for medications and not talk about some of the fundamental lifestyle changes that can have a huge impact.