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7
Health-Care Professionals:
Strategies and Actions
for Implementation
I N THE UNITED STATES, there has been a growing public aware-
ness of the role of nutrition in the etiology of many chronic degen-
erative diseases and a corresponding demand for information and
assistance concerning diet and disease relationships. The U.S. popu-
lation looks more and more to health-care professionals to provide
clear information confirming this linkage and to establish practical
guidelines for dietary regimens that will help to prevent or delay the
onset of disease. At the same time, multiple forces, including the
need to contain the cost of medical services, may be helping to renew
interest among health-care professionals and the public in preventive
measures. Good nutrition practices are an essential component of
efforts to prevent or control such diseases as atherosclerosis, cancer,
hypertension, diabetes, and osteoporosis. Health-care professionals
must respond to these increasing needs.
The committee defined health-care professionals as those whose
work deals primarily with food and nutrition (e.g., registered dietitians,
nutritionists, and nutrition educators); those for whom food and nu-
trition issues are important but secondary (e.g., physicians and nurses);
and scientists whose basic research concerns the role of food in the
etiology of disease. Thus, the target audiences for the implementation
strategies and actions proposed in this chapter include nutrition scientists
and virtually everyone professionally trained in the delivery of health
care.
Increasing expectations that health-care professionals will include
nutritional guidance as an integral component of all primary care
168
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HEALTH-CARE PROFESSIONALS
169
come at a time when both positive and negative forces are at work.
The positive forces include a growing awareness of the escalating
social and economic costs of preventable disease and disability, the
wide scientific consensus on the nature of dietary recommendations,
the increased scope and number of programs in health promotion,
and growing evidence of the success of such efforts in reducing nutrition-
related risk factors for chronic disease.
The negative forces include inadequate time and lack of compensation
to provide the kinds of nutritional guidance that individuals may
desire or need, the perception that many people lack interest in eat-
ing better and that they do not follow recommended diets, and inad-
equate knowledge and skills needed to teach people how to improve
their diets. A major impediment to implementation of dietary rec-
ommendations is the inadequate preparation of health-care profes-
sionals (primarily those outside the nutrition field) for these new and
expanding roles as promoters of good nutrition and providers of ba-
sic information on the subject. Inadequate preparation of many phy-
sicians for this role has been recognized for many years (Council on
Food and Nutrition, 1963; NRC, 1985~.
Fortunately, several voluntary organizations, government agencies,
and private associations are attempting to help health-care profes-
sionals prepare for their expanded role. Examples include the National
Center for Nutrition and Dietetics (ADA, 1990), Project LEAN (Low-
Fat Eating for America Now) (Henry I. Kaiser Family Foundation,
1988), the Healthy Mothers, Healthy Babies Public Information Program
(DHHS, 1990b), and the national campaigns on cholesterol and high
blood pressure education (Cleeman, 1989; Lenfant, 1986; Roccella and
Ward, 1984~. These and other such programs aim to inform consumers
how to improve their dietary practices and to help health-care pro-
fessionals become better promoters and teachers of nutrition. How-
ever, increased coordination and cooperation among such groups and
programs are needed to perform this important and complex task
effectively.
MULTIPLE ROLES
To implement dietary recommendations, health-care professionals
must perform multiple roles, including educational, modeling, orga-
nizing, advisory, and investigative roles. Not all these professionals
have the same needs for nutrition information to perform each of
these roles effectively.
In their educational role, health-care professionals may serve as re-
sources on nutrition, food, and health in a variety of ways such as in
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IMPROVING AMERICA'S DIET AND HEALTH
the preparation of primary and secondary school teachers, the train-
ing of health-care professionals (both students and practitioners in
classroom settings and in continuing education programs), the moti-
vation and education of individual patients in clinical settings, education
of the public, and providing patients with dietary assessments and
counseling. Since intellectual acceptance of knowledge by itself rarely
fosters lasting change (see Chapter 3), practitioners will need to learn
about the forces that govern behavior changes in order to help moti-
vate patients and assist them in acquiring the skills needed to achieve
and sustain enduring healthful dietary practices.
By following dietary recommendations themselves, health-care
professionals serve as highly credible role models for patients and
the public. In this modeling role, they can provide information and
dietary advice based in part on their personal experiences that may
help others to improve their eating habits.
As organizers, health-care professionals can initiate or contribute to
community programs to improve nutrition. To accomplish this, they
may act as individuals or work through professional societies or other
health care-related organizations.
The advisory role of health-care professionals includes providing
legislators and government officials with the information needed to
promulgate desirable regulations and guidelines pertaining to food,
nutrition, and health policy.
The investigative role is carried out primarily by health-care pro-
fessionals in institutions or organizations involved in basic or applied
research. However, community practitioners can play this role as
well. As an example, the recognition that contaminated tryptophan
supplements may cause serious toxicity was made by a practicing
physician (Altman, 1989; CDC, 1989~. There is great need for additional
insights into the causal relationships between diet, genetic factors,
and organic diseases, for more knowledge of the factors that govern
behavior change, and for information on how to mobilize communities
to promote healthy behaviors. It is certain that there will be additional
discoveries in these areas. Thus, current dietary recommendations,
which represent the best understanding of nutrition science to date,
may need to be revised in the future. (See Chapter 9 for suggested
research topics.)
CURRENT STATUS AND FUTURE NEEDS OF SOME
HEALTH-CARE PRACTITIONERS
In this section, nutritionists, physicians, nurses, health educators,
and other health-care practitioners are described in terms of their
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171
roles and needs in implementing dietary recommendations. The or-
dering of these professional groups does not reflect any hierarchy of
importance to their respective and complementary tasks.
Nutritionists
The pool of qualified nutrition personnel needed to implement
dietary recommendations is varied. It consists of nutritionists work-
ing in a variety of settings, including state and local health departments,
community nutrition programs, policy and advocacy organizations,
educational institutions at all levels, and research facilities. This pool
includes approximately 44,000 registered dietitians (American Dietetic
Association, personal communication, 1990), 4,700 public health nutrition
personnel (Kaufman, 1989), 2,800 scientists in the American Institute
of Nutrition (American Institute of Nutrition, personal communication,
1990), and 270 physicians board certified in nutrition (American Board
of Nutrition, personal communication, 1990~. Because some nutrition
professionals are members of two or more of these categories and
some are not included in any of them, the total number involved in
this effort will be different from this total.
To deepen the knowledge of nutrition specialists and enhance their
skills in teaching a wide variety of publics to base their eating patterns
on dietary recommendations, traditional education programs must
be improved. For example, curricula must emphasize both the social
and behavioral aspects of promoting dietary changes as well as the
scientific basis of the recommendations. In addition, curricula should
include relevant material from the food and agricultural sciences.
This requires a delicate balance. Too much emphasis on the scientific
fundamentals could lead to omission of the practical aspects of nutrition
and dietary change. Public health and other community-based nutrition
specialists who work actively on promoting health among target
populations need additional training on how to integrate into their
programs the growing evidence on diet and health relationships and
how to manage complex community intervention programs.
Registered dietitians and other nutrition specialists must be trained
adequately to translate dietary recommendations into practical advice
and to provide menu alternatives that consumers can understand
and adopt. Students who plan to work in institutional food services
must learn the techniques for adapting dietary recommendations to
all aspects of food service management: menu planning, food purchas-
ing, food preparation (including modification of recipes), meal service,
and merchandising. Nutritionists and dietitians in food-service man-
agement positions have many opportunities to promote public health
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IMPROVING AMERICA'S DIET AND HEALTH
by helping both clients and food-service providers (e.g., cooks) fulfill
their responsibilities to make more nutritionally desirable foods available
to the public. As educators, nutrition specialists can help other health-
care professionals acquire the information and skills needed to provide
basic community nutrition education. Nutritionists and dietitians
should be committed to following dietary recommendations and teaching
others how to apply them wherever they work, including business
and industry, private practice, academia, and government.
Physicians
A 1985 Food and Nutrition Board (FNB) committee concluded that
nutrition education in U.S. medical schools is largely inadequate (NRC,
1985~. Among the schools surveyed, it observed "a distinct lack of
organizational structure and administrative support for nutrition
programs" (p. 97~. To ensure that nutrition programs become a per-
manent part of the medical school curriculum, the committee suggested
that responsibility for them be vested in a separate department or
division of clinical nutrition. The committee further recommended
the establishment of a mechanism to monitor changes, if any, in the
status of nutrition education in U.S. medical schools.
The 1985 FNB committee proposed explicit guidelines that would
best incorporate principles of nutrition in the basic and clinical curricula
of medical schools. Because the administrative structures of U.S.
medical schools are so diverse, it was acknowledged that each school
would be obliged to devise its own nutrition program, implementation
strategy, and faculty structure. The committee recognized that a vigor-
ous program in nutrition must always incorporate the latest investigative
findings and that a mandated, inflexible curriculum is inherently
outmoded. Nevertheless, it emphasized that certain broad areas pertaining
to nutrition are an indispensable part of medical education. These
areas include energy balance, the role of specific nutrients and dietary
components, nutrition at different stages of the life cycle, assessment
of nutritional status, protein-energy malnutrition, the role of nutrition
in disease prevention and treatment, and any risks stemming from
poor dietary practices because of individual, social, or cultural
idiosyncrasies (Weinsier et al., 1989~. All these areas need to be rethought
in relation to dietary recommendations, and the curriculum needs
broadening to include elements of preventive medicine. For example,
during the clinical training phase of medical school, students could
learn basic nutrition counseling skills based on the communication/
persuasion and social learning models described in Chapter 3.
The number of U.S. medical schools with required nutrition courses
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HEALTH-CARE PROFESSIONALS
173
dropped from 46 in 1981-1982 to 34 in 1987-1988 (Winick, 1989~.
Concomitantly, however, general nutrition education has been
strengthened in most medical schools. The framework for an effec-
tive program is operating at the Emory University School of Medi-
cine in Atlanta, Georgia, where an executive associate dean initiated
a Nutrition Planning Committee composed of faculty from both basic
and clinical science departments. All committee members have a
professional interest in nutrition science, and all are active investigators
in this field. The committee coordinates, advises, and participates in
matters of curriculum design, recruitment of faculty in the area of
nutrition, and guidance of the graduate degree programs in this field.
It also supervises the coverage of nutrition throughout the campus.
Furthermore, the committee coordinates its intramural activities with
the other southeastern medical schools through SERMEN (Southeastern
Region of Medical School Educators in Nutrition), which has a central
office at the Medical College of Georgia in Augusta and a testing
service based at the University of Alabama in Birmingham. Another
apparently effective program is operating at the University of Texas
Health Science Center in San Antonio (Young, 1988~. A recent paper
presents strategies to fit nutrition in the medical curriculum (Kushner
et al., 1990~.
Summaries and excerpts from the FNB reports Recommended Dietary
Allowances (NRC, 1989b) and Diet and Health: Implications for Reducing
Chronic Disease Risk (NRC, 1989a) as well as The Surgeon General's Re-
port on Nutrition and Health (DHHS, 1988) should serve as resources
for medical students learning about the relationships between nutri-
ent intake and dietary patterns to the maintenance of health and risk
of chronic disease. Other resources will be needed to teach basic
nutrition concepts and such topics as nutritional therapies to treat
specific diseases.
Nurses
At present, fundamental nutrition courses are not a prominent fea-
ture of baccalaureate or master's degree programs in nursing, although
narrow elements of diet planning and disease-oriented diet therapy
are incorporated into many required courses in the nursing curricula.
Most programs that do provide nutrition courses are part of university
medical centers such as the University of Washington (Seattle) School
of Nursing (University of Washington, 1989~. In the program descriptions
of many nursing schools, there is no mention of nutrition education
of patients as being a responsibility of nurses.
The inclusion of both basic and applied nutrition courses in nurs
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IMPROVING AMERICA'S DIET AND HEALTH
ing education has become increasingly important in light of the ex-
panding roles of nurses in health care. Nurses often serve as the
gatekeepers to patient care in primary health care units. In many
clinical settings, for example, nurses conduct entry interviews, record
pertinent historical details, act as triage coordinators, and frequently
assume responsibility for the exit instructions regarding medications,
diet, and other life-style changes. It is likely, then, that nurses (including
registered nurses, nurse practitioners, and licensed midwives) work-
ing in various sites (e.g., hospitals, schools, clinics, and offices) can
influence the eating habits of the public. To do so effectively, however,
they must be adequately educated in nutrition, be sufficiently motivated
to teach and encourage their patients to make dietary changes, and
eat well themselves. Nurses have more daily contacts and interviews
with patients in health-care settings than do those in any other professional
group and thus have a great potential for influencing their clients.
Health Educators
Health educators work to promote health and prevent disease in
state and local public service departments, even when their primary
activities are geared to improving educational systems and social welfare
or health-care policies. Their training should place additional emphasis
on nutrition concepts and nutrition education methods to prepare
them for their expanded roles in implementing dietary recommendations.
Chairs of health education departments should draw on faculty out-
side the department with expertise in nutrition science and nutrition
education to serve as instructors and advisers in the nutrition component
of their programs. Practicing health educators should use the services
and resources of food and nutrition specialists in their communities.
In addition, they should improve their abilities to implement dietary
recommendations by having access to electronic networks of nutrition
literature and telephone or computer hotlines that could quickly provide
them with accurate and practical information needed in specific situations.
More effective use should be made of another group of health
educators the more than 3,000 home economists with the Cooperative
Extension Service (CES) who disseminate nutrition information to
consumers on an individual and group basis throughout the United
States (Tope, 19901. In 1989, more than 10 million people participated
in CES-organized nutrition programs, many of them provided through
health departments, schools, churches, and local businesses.
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HEALTH-CARE PROFESSIONALS
Other Health-Care Professionals
175
Many other health-care professionals, including dentists, pharma-
cists, home economists, physician assistants, and medical epidemi-
ologists, can be important sources of dietary information. All have
unique opportunities to offer education and practical examples of the
need for improved nutrition to their clients and colleagues. For example,
dentists might inform their patients about diet-related measures for
preventing and controlling dental caries, and pharmacists can help to
disseminate the message that healthy people can and should obtain
adequate amounts of essential nutrients by eating a variety of foods.
Both can speak to colleagues and other health-care providers at con-
tinuing education programs about their successes and failures in
promoting dietary recommendations.
STRATEGIES AND ACTIONS FOR HEALTH-CARE
PROFESSIONALS
The committee developed three strategies and associated actions
for health-care professionals to implement dietary recommendations.
STRATEGY 1: Raise the level of knowledge among all health-
care professionals about food and nutrition and the relationships
between diet and health.
ACTION 1: Establish within the faculty of every health-care
professional school an identifiable program with overall responsibility
for planning and developing a research and education agenda in
human nutrition.
Considerable attention should be given to the nutrition education
of physicians and nurses, since these two groups of professionals
customarily represent the first contacts made by people seeking health
care. These initial contacts, which number in the millions per day,
are an excellent opportunity to provide patients with initial guidance
and information about dietary recommendations. Patients who need
more elaborate guidance or specific dietary modifications can be referred
to qualified nutritionists and registered dietitians who have specialized
knowledge and additional skills in this area.
One barrier to the successful implementation of this action is the
limited number of faculty available to constitute an effective nutrition
committee at most health-care professional schools. (Action 2 below
is aimed at overcoming this barrier.) Another more difficult barrier is
the institutional hesitation to expand curricular coverage (Nestle, 1988~.
However, an efficiently coordinated program might not require an
increase in the hours spent on nutrition but, rather, an alteration of
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IMPROVING AMERICA 'S DIET AND HEALTH
the existing hours by rearranging and coordinating coverage. A third
barrier relates to coordination. In fields such as nutrition, which cut
across many basic and clinical areas, some coordination with the cur-
ricula of related subject areas is essential but often difficult to achieve.
The establishment of an identifiable program with responsibility
for planning, research, and education in human nutrition might be
initiated by an individual school or be a cooperative effort among
schools at a health center. A visibly supportive role by the university's
administrative leadership is needed to ensure the success of the ef-
fort.
ACTION 2: Establish a program within the Public Health Service
to support the training offaculty in nutrition. The goal should
be at least one nutritionfaculty member per health-care professional
school for each of the licensed graduate programs in the health-
care professions.
This program might be patterned after the current Preventive Car-
diology Academic Award, which has been funded through the National
Heart, Lung, and Blood Institute (NHLBI) at the National Institutes
of Health (NIH) since 1979. It gives a competitively awarded 5-year
grant to one faculty member in individual medical schools to develop
programs in preventive cardiology. The grant provides up to 50% of
the faculty person's salary plus funds to support the development
and implementation of the program. The aim of the program is to
have the school maintain the program after the completion of the 5-
year period.
A nutrition award program could support a faculty member with
clinical research interests in human nutrition. That faculty member
would become an active member of the school's nutrition committee
and would be expected to participate in all the campus activities
related to nutrition. The award might be funded and administered
by more than one NIH institute.
The major barrier, beyond the availability of funds, would be the
maintenance of an active program on the campus after expiration of
the grant. Limited availability of suitable faculty candidates for the
award might also be a problem, but one that would diminish as more
people in the various health-care professions devote themselves principal-
ly or exclusively to nutrition.
ACTION 3: Materials emphasizing dietary recommendations
for students in the health-care professions should be prepared by
curriculum committees, authors, publishers, and others with in-
terests in curriculum development. Such materials should include
course syllabi at varying levels of complexity, batteries of examination
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HEALTH-CARE PROFESSIONALS
177
questions, relevant bibliographic listings, audiovisual teaching
instruments, and self-education computer programs.
Some clusters of schools (e.g., medical schools in the southeastern
states) have already combined their resources in nutrition education
and have made such teaching materials available to other schools
(Feldman et al., 1989~. A similar amalgamation of resources in clini-
cal nutrition should be established for health-care professional schools.
Individual schools and faculty may wish to use only materials devel-
oped in house. Resistance to materials generated by outside authorities
should be overcome, however, by the availability of authoritative
reports such as Diet and Health (NRC, 1989a), The Surgeon General's Report
on Nutrition and Health (DHHS, 1988), and the curricular materials
developed by broad-based groups.
Clinical nutrition issues should be emphasized in such settings as
informal nutrition rounds in both inpatient and outpatient settings,
conferences, and formal seminars. Printed and audiovisual presentations
should be made available to teaching institutions unable to develop
such programs.
ACTION 4: Expand nutrition education of health-care professionals
at all levels. Certification and licensing bodies involved in the
education of health-care professionals should require a demonstrated
knowledge of nutrition.
There is a need to increase the exposure of health-care professionals
to clinical nutrition concepts in basic and graduate training as well as
in continuing education. Students should be required to demonstrate
their knowledge of nutrition and nutrition education methods by re-
sponding correctly to test questions on diet and health. Such questions
should be incorporated into examinations assembled and sponsored
by such professional bodies as the National Board of Medical Exam-
iners (Winick, 1988~. As a necessary step in bringing this about,
professionals with expertise in nutrition should be asked to serve as
advisory board members of licensing and accrediting agencies.
More continuing education programs in nutrition should be developed
for health-care professionals. One useful example is Rx Nutrition: Good
Health in Practice, a 2-year program designed to help physicians bet-
ter understand connections between diet and disease and to provide
them with practical guidelines to modify their own and their patients'
eating habits (Health Learning Systems, Inc., 1989~. This program is
based on the recommendations in the Diet and Health report (NRC, 1989a).
Barriers to the acquisition of this new knowledge are both concep-
tual and practical, especially for physicians. Nutrition is not now
identified as a specific component of most medical residency or graduate
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IMPROVING AMERICA'S DIET AND HEALTH
training programs (Boker et al., 1990). Certain medical specialties (e.g.,
gastroenterology and pediatrics) cover many elements of nutrition,
but their coverage is rarely coordinated or focused. Another practical
problem is that many programs in health-care educational institu-
tions now compete for a limited allotment of teaching time. Further-
more, courses in nutrition do not yet teach students in most of the
health-care professions the skills needed to motivate and enable people
to make long-term improvements in their dietary patterns.
In medical schools, nutrition can be made part of the curricula in
virtually all clinical areas (e.g., prenatal nutritional requirements in
obstetrics). When nutrition is made an integral part of the broader
program of preventive medicine, it is more likely to be accepted and
maintained. Moreover, health-care practitioners should be encouraged
to use the professional skills of registered dietitians and others with
nutrition expertise in educating, motivating, and assessing the nutri-
tional status of patients.
STRATEGY 2: Contribute to efforts that will lead to health-
promoting dietary changes for health-care professionals,
their clients, and the general population.
ACTION 1: Encourage efforts to implement dietary recommen-
dations in a coordinated manner for maximum effectiveness and
to avoid unnecessary duplication.
Two successful models have been developed for coordinating ac-
tivities designed to control hypertension and hypercholesterolemia-
the National High Blood Pressure Education Program (NHBPEP) (Roccella
and Ward, 1984) and the National Cholesterol Education Program
(NCEP) (Cleeman, 1989~. Both programs were established under the
direction of the NHLBI. Each consists of a coordinating committee
composed of member organizations representing agencies within the
federal government as well as major medical associations, voluntary
health organizations, and various community programs. These commit-
tees mobilize and coordinate the resources and energies of participat-
ing organizations to achieve the goals of their respective programs.
The success of both NHBPEP and NCEP demonstrates that such
coordination is feasible, enabling more effective overall attainment of
goals, while avoiding wasteful duplication even as each member or-
ganization is encouraged to continue its individual efforts. A recent
nutrition initiative based in part on the NHBPEP and NCEP models
is Project LEAN (Low-Fat Eating for America Now). Sponsored by
the Henry I. Kaiser Family Foundation (1988), its goals are to reduce
the fat intake of the U.S. population to 30% of calories by 1998, to
increase the availability and accessibility of low-fat foods, and to
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HEALTH-CARE PROFESSIONALS
179
increase collaboration among national and community organizations
in achieving these goals.
i
ACTION 2: Encourage all health-care professionals to integrate
nutrition information into their multiple counseling, treatment,
skills training, and follow-up sessions with individual clients
and patients.
Health-care professionals should make the provision of nutrition
nformation a prominent part of their hospital exit interviews and
office visits with patients. In its recent report on health objectives for
the nation, the U.S. Department of Health and Human Services (DHHS,
1990a) recommends that by the year 2000 at least 75% of primary care
providers should routinely provide nutrition assessment and counseling
to their patients or refer them to nutrition experts. Hospital rounds
could also be used to educate both health-care professionals and pa-
tients about pertinent nutritional matters. Another means to implement
this action is to establish standards for evaluation of nutritional status
and instruction in clinical practice, particularly for such critical activities
as pregnancy monitoring, child health visits, preemployment and school
examinations, and clinical encounters with postoperative patients and
elderly people.
It is important to note that this action cannot be implemented until
third-party payers provide adequate reimbursement for nutrition coun-
seling to compensate those whose skills and time would be required.
Third-party payers must recognize the potential savings in medical-
care expenditures that can accrue if nutrition information conveyed
by health-care professionals reduces the prevalence of chronic dis-
ease in the United States.
ACTION 3: Provide leadership, resources, and personnel for
the dissemination of sound nutritional advice.
Appropriate health-care professional societies should prepare and
disseminate valid information to the media and serve as a permanent,
readily available source for those seeking authoritative information
and guidance on nutrition. In local communities, there are many
opportunities for health-care professionals to carry out this function
as individuals, through their professional societies, and through local
affiliates of voluntary organizations. For example, they can take leader-
ship roles in community organizing around nutrition issues; aid in
the creation of a nutrition coalition or consortium that develops and
coordinates local nutrition programs; and use newspapers, radio, and
television to provide information and articulate their positions, thereby
influencing consumer knowledge and behavior. (See Chapter 3 for a
discussion of the media.)
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IMPROVING AMERICA'S DIET AND HEALTH
ACTION 4: Working as individuals or through professional
societies, provide guidance to regulatory and legislative bodies
concerned with the establishment of dietary standards and with
rules and policies governing the production, harvesting, process-
ing, preservation, distribution, and marketing offood products.
Federal, state, and local legislators need to be better informed about
nutrition and food issues. As members of national organizations and
local communities, health-care professionals should offer guidance to
policymakers on these subjects. For example, they might provide
forums on food and nutrition issues for elected officials and link
them with relevant activities or proposed initiatives in their local
communities. The FNB, whose board and committees are composed
primarily of health-care professionals, would continue to provide expert
advice when called upon.
ACTION 5: Specialists in human nutrition and food science,
working through their professional organizations, should distribute
practical information such as menus, recipes, and ideas for health
promotion initiatives to private and public providers of meals.
To implement this action, nutrition and food specialists should
begin with their own hospital food services and branch out to school
cafeterias, faculty clubs, commercial restaurants, nursing and conva-
lescence homes, corporate dining rooms, and other appropriate settings.
By providing this kind of practical information, health-care professionals
may motivate meal providers to improve the variety of their menu
offerings by including more nutritionally desirable foods and constructing
meals that adhere to the principles of dietary recommendations.
ACTION 6: Serve as role models by following dietary recom-
mendations (and practicing ether healthy hchaviors) as often as
possible.
Health-care professionals should recognize that when they person-
ally follow dietary recommendations, they are very likely to improve
their own health and longevity, serve as role models for those who
seek their professional guidance, and develop competence in the same
self-management skills they must teach their patients. Therefore, the
principles of dietary recommendations should be followed, for example,
in the preparation of meals and snacks served at all meetings of health-
care professionals, at client luncheons and dinners, at receptions, and
in hospital cafeterias. One organization implementing this action is
the American Public Health Association (APHA), which uses the Di-
etary Guidelines for Americans (USDA/DHHS, 1985) as a guide for
planning meals and snacks at its meetings (APHA, 1987~.
· ,7
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HEALTH-CARE PROFESSIONALS
STRATEGY 3: Intensify research on the relationships
between food, nutrition, and health and on the means to
use this knowledge to promote the consumption of healthful
diets.
ACTION 1: Encourage sponsors of research to give high priority
to research into diet and disease relationships and to developing
innovative ways to use that knowledge in educating health-care
professionals and the public about nutrition.
In the public sector, intramural and extramural nutrition-oriented
investigations should be stimulated through legislative, regulatory,
and administrative channels. In the private sector, foundations, charities,
and the food industry should be encouraged to participate in the
underwriting of nutrition research. Unfortunately, although several
public and private agencies and foundations fund nutrition research,
few grants are primarily concerned with the dietary components of
disease or in the educational and regulatory strategies to implement
knowledge of diet and disease relationships.
Nlarious food industry associations (e.g., the National Dairy Council,
the American Meat Institute, and the Egg Nutrition Center) already
fund nutrition research. There is a lack of industrywide collabora-
tion in this direction, however, which may preclude the giving of
needed attention to research areas that are not of interest to the individual
181
grantors. Moreover, the credibility of research that is supported by
industry groups may be questioned by many academicians and the
public. Furthermore, the amount of morrey directed to research not
oriented to specific products is very modest. Food and beverage
companies are encouraged to collaborate to provide generous levels
of untargeted funding. For example, if the food industry were to
contribute substantially to a central, privately managed nutritional
science fund, the research would be seen as more credible, and both
industry and the public would benefit.
REFERENCES
ADA (American Dietetic Association). 1990. NCND thanks and welcomes corporate
donors. ADA Courier 29(7):1.
Altman, L.K. November 28, 1989. How medical detectives identified the culprit be-
hind a rare disorder. New York Times. C3.
APHA (American Public Health Association). 1987. APHA meal function guidelines
for health conscious caterers. Photocopy. 1 p.
Boker, J.R., R.L. Weinsier, C.M. Brooks, and A.K. Olson. 1990. Components of effec-
tive clinical-nutrition training: a national survey of graduate medical education
(residency) programs. Am. J. Clin. Nutr. 52:568-571.
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Representative terms from entire chapter:
nutrition education
