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APPENDIX B Summary of Committee's Major Recommendations PRINCIPAL IMPLEMENTATION STRATEGIES 1. Governments and health-care professionals must become more active as policymakers, role models, and agenda setters in imple- menting dietary recommendatior~s. 2. Improve the nutrition knowledge of the public and increase the opportunities to practice good nutrition. 3. Increase the availability of health-promoting food. RECOMMENDATIONS TO THE PUBLIC SECTOR STRATEGY 1: Improve federal efforts to implement di- etary recommendations. ACTION 1: The executive branch should establish a coordinat- ing mechanism that would promote the implementation of di- etary recommendations. ACTION 2: Encourage members of the U.S. Congress and state legislative bodies to play active roles in the implementation of dietary recommendations. STRATEGY 2: Alter federal programs that directly influ- ence what Americans eat so as to encourage rather than impede the implementation of dietary recommendations. This effort should affect food assistance, food safety, and 218

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APPENDIX B nutrition programs, as well as farm subsidy) tariff, and trade programs. ACTION 1: Revise current U.S. Department of Agriculture (USDA) regulations governing the child and family nutrition programs to comply with dietary recommendations and train federal, regional, state, and local personnel administering the programs to implement the recommendations. ACTION 2: Revise current regulations governing the Nutri- tion Program for Older Americans (which provides congregate meals and home-delivered mealsJ to conform to the principles of dietary recommendations and train federal, regional, state, and local personnel administering the programs accordingly. ACTION 3: USDA and the U.S. Department of Health and Human Services (DHHS) should ensure that food and health programs serving all special populations conform to dietary rec- ommendations. ACTION 4: Ensure that the education and information compo- nents of the foregoing federalfood assistance and nutrition pro- grams are consistent with dietary recommendations. ACTION 5: Incorporate dietary recommendations into current rules and regulations governing commodity purchases. STRATEGY 3: Change laws, regulations, and agency practices that have an appreciable but indirect impact on consumer dietary choices so that they make more foods to support nutritionally desirable diets available. Examples are food grading and labeling laws and standards of identity for a number of food products. ACTION 1: Improve food labeling and food description, pro- duction, and processing regulations to permit consumers to make better informed choices. ACTION 2: Develop and adopt regulations governing food de- scriptions, grading, and nomenclatural practices. ACTION 3: Improve the nutritional attributes of animal products. STRATEGY 4: Enable government feeding facilities to serve as models to private food services and help people meet dietary recommendations. ACTION 1: The Office of the Secretary of the U.S. Department 219

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220 APPENDIX B of Veterans Affairs should direct its health-care personnel to follow dietary recommendations in all of its food and health care systems. ACTION 2: The surgeons general of the Army, Navy, and Air Force within the Department of Defense (DODJ should develop a plan for implementing dietary recommendations in all aspects of the DOD food and health-care systems. ACTION 3: The DOD's food and beverage services and prac- tices should be revised to conform to dietary recommendations. ACTION 4: Urge the director of the Federal Bureau of Prisons to examine the feasibility of providing diets in line with dietary recommendations, recognizing the complexity of the correctional system and the special role offood in correctionalfacilities. ACTION 5: The General Services Administration should en- sure that food contracts and monitoring systems are made to conform to the principles of dietary recommendations. ACTION 6: Department secretaries should encourage govern- ment employees to consume diets that meet dietary recommenda- tions. ACTION 7: The U.S. government personnel ultimately respon- sible for funding official meal functions should offer meals that are consistent with the principles of dietary recommendations. STRATEGY 5: Develop a comprehensive research, moni- toring, and evaluation plan to achieve a better understanding of the factors that motivate people to modify their eating habits and to monitor the progress toward implementa- tion of dietary recommendations. ACTION 1: The secretaries of USDA and DHHS should man- date increased amounts of intramural research that relate to implementation of dietary recommendations and give high prior- ity to the funding of extramural research in this area. ACTION 2: Improve the National Nutrition Monitoring Sys- tem and provide it with adequate resources. RECOMMENDATIONS TO THE PRIVATE SECTOR STRATEGY 1: Promote dietary recommendations and motivate consumers to use them in selecting and prepar- ing foods and in developing healthful dietary patterns.

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APPENDIX B ACTION 1: Make consumers aware of dietary recommendations and their importance and how available products and services can be used to meet them. ACTION 2: Contribute to efforts to improve the nutrition la- beling offood so that it better assists consumers in making informed. nutritionally desirable food choices. O , ACTION 3: Provide consumers with information at points of purchase so that they may assess quickly some of the nutrition attributes of specific products and brands. STRATEGY 2: Continue to increase the availability of a wide variety of appealing foods that help consumers to meet dietary recommendations. ACTION 1: Develop more nutritionally desirable products that appeal to consumers. ACTION 2: Contribute to efforts to revise, or develop as appro- priate, food-quality criteria (such as standards of identity and grading), pricing structures, andfood product descriptors to promote the production of more nutritionally desirable food products. ACTION 3: Engage in practices leading to the greater avail- ability of nutritionally desirable products that will assist con- sumers in meeting dietary recommendations. RECOMMENDATIONS TO HEALTH-CARE PROFESSIONALS 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 respon- sibility for planning and developing a research and education agenda in human nutrition. ACTION 2: Establish a program within the Public Health Ser- vice to support the training offaculty in nutrition. The goal should be at least one nutrition faculty member per health-care professional schoolfor each of the licensed Graduate programs in the health-care professions. - O ~r -o 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 221

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222 APPENDIX B terests in curriculum development. Such materials should in- clude course syllabi at varying levels of complexity, batteries of examination questions, relevant bibliographic listings, audiovisual teaching instruments, and self-education computer programs. ACTION 4: Expand nutrition education of health-care profes- sionals at all levels. Certification and licensing bodies involved in the education of health-care professionals should require a demonstrated knowledge of nutrition. 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 mannerfor maximum effectiveness and to avoid unnecessary duplication. 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. ACTION 3: Provide leadership, resources, and personnelfor the ~ dissemination of sound nutritional advice. ACTION 4: Working as individuals or through professional so- cieties, provide guidance to regulatory and legislative bodies concerned with the establishment of dietary standards and with rules and policies governing the production, harvesting, processing, pres- ervation, distribution, and marketing offood products. ACTION 5: Specialists in human nutrition and food science, working through their professional organizations, should dis- tribute practical information such as menus, recipes, and ideas for health promotion initiatives to private and public providers of meals. ACTION 6: Serve as role models by following dietary recom- mendations (and practicing other healthy behaviors) as often as possible. STRATEGY3: 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.

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APPENDIX B ACTION 1: Encourage sponsors of research to give high prior- ity to research into diet and disease relationships and to deveZop- ing innovative ways to use that knowledge in educating health- care professionals and the public about nutrition. RECOMMENDATIONS FOR EDUCATION OF THE PUBLIC STRATEGY 1: Ensure that consistent educational messages about dietary recommendations reach the public. ACTION 1: Initiate meetings of leaders and representatives of national groups (e.g., interest groups, professional associations, and Cooperative Extension Service educators) to explore com- mon interests in implementing dietary recommendations and to develop a series of common educational initiatives related to the attainment of that goal. ACTION 2: Review materials on diet and health prepared for the public by various professional groups and organizations to achieve consistency and ensure compatibility with dietary rec- ommendations. ACTION 3: Convene an ad hoc committee composed of authors and publishers of leading nutrition textbooks to develop a series of broad guidelines that publishers could use to provide in their publications consistent and authoritative information on dietary recommendations and their scientific rationale. ACTION 4: Constitute a panel to review and evaluate nutri- tion education materials made available to schoolteachers from various food industry sources. STRATEGY 2: Incorporate principles, concepts, and skills training that support dietary recommendations into all levels of schooling kindergarten through college. ACTION 1: Design a model curriculumfor teachingfood skills, nutrition, and health from kindergarten through grade 12. ACTION 2: During the development of the curriculum proposed in Action 1, identify teacher-tested lessons on health, nutri- tion, and food selection and preparation skills- suitablefor use in a variety of classroom settings at different grade levels. ACTION 3: Professional nutrition, health promotion, and edu- cation organizations in each state should organize their members 223

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224 APPENDIX B (and through their members, local parents) to lobby state legisla- tures and urge state boards of education to mandate the inclusion of at least one food skills, nutrition, and health course in the requirements for teacher preparation in each state. ACTION 4: Revive, at the level of at least $0.50 per student, the USDA-administered Nutrition Education and Training (NE TJ Program that stimulated so much activity related to nutrition O education in the late 1970s. ACTION 5: Offer a nutrition course or, at a minimum, a life science course with a well-developed nutrition component at in- stitutions of higher learning. ACTION 6: Offer each student in grades 7 through college on a periodic basis e.g., every 3 years) a computer analysis of his or her diet and a professional evaluation of how the student's food habits conform to dietary recommendations. STRATEGY 3: Ensure that children in child-care programs (including out-of-home care programs and family-, group-, or center-based programs) receive nutritious meals served in an environment that takes account of the importance of food in children's physical and emotional well-being. ACTION 1: Establish an interdisciplinary task force to oversee food-related matters involving children in child-care programs. This task force would include experts in pediatrics, nutrition, psychology, anthropology, and child development alone with child- care providers and parents. ACTION 2: Public policy committees in nutrition, medical, and other health-related organizations should work to develop and pass legislation to require thatfoods served to children help them to meet dietary recommendations. The Child and Adult Care Food Program standard of USDA should be used as a quality . . minimum. STRATEGY 4: Enhance consumers' knowledge and the skills they need to meet dietary recommendations through appropriate food selection and preparation. ACTION 1: Develop a consumer manual to present strategies that can be used to influence local food providers (and others who play important roles in the food system) to increase the availability of foods that help people meet dietary recommendations.

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APPENDIX B ACTION 2: Prepare an inexpensive, continually updatablefoods data bank to inform consumers, food planners, and others about the nutritional content, composition, and production/processing history of the products available to them. STRATEGY 5: Establish systems for designing, imple- menting, and maintaining community-based interventions to improve dietary patterns. ACTION 1: Professional organizations concerned with food, nutrition, and health should work to engage community leaders in the development of community-based programs promoting di- etary recommendations. ACTION 2: Encourage schools of higher learning in various regions of the country to develop programs for educating and updating individuals in the skills needed to play key roles in community-based nutrition education programs. STRATEGY 6: Enlist the mass media to help decrease consumer confusion and increase the knowledge and skills that will motivate and equip consumers to make health- promoting dietary choices. ACTION 1: Develop a series of social marketing campaigns to disseminate dietary recommendations. ACTION 2: Appoint a committee of experts in nutrition educa- tion, child development, social influence, and media to review past attempts to regulate television food advertising to children. ACTION 3: Appoint a standing committee to coordinate the vast number of media activities necessary to increase consumer knowledge about dietary recommendations and their application and to decrease consumer confusion. ACTION 4: Establish a taskforce of social scientists to examine the utility of national entertainment television as a community- organizing tool that can be used to enhance efforts of local health agencies in encouraging appropriate dietary changes. DIRECTIONS FOR RESEARCH 225 1. Improve methods to characterize what people actually eat, es- pecially over long periods during which dietary patterns change. 2. Increase understanding of the existing and potential determi

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226 APPENDIX B nants of dietary change and how this knowledge can be used to pro- mote more healthful eating behaviors. 3. Continue research to develop new food products and modify both the production and processing of existing products to help con- sumers more easily meet dietary recommendations. 4. Review and improve government and private-sector policies that directly and indirectly affect the availability of particular foods and the promotion of healthful dietary patterns. 5. Determine how implementors of dietary recommendations at all levels (e.g., supermarket managers, physicians, and high school health teachers) can more effectively teach the basis of the recom- mendations and motivate people to follow them. 6. Investigate the costs and benefits of implementing dietary rec- ommendations as proposed by this committee and by others.