In their VitalSigns Periodical, the Centers for Disease Control recently shared the shocking fact that “Reducing the sodium Americans eat by 1,200mg per day could save up to $20 billion a year in medical costs.” [1] High sodium content isn’t the only problem with the Standard American Diet, or the typical American eating habits, for that matter. The typical American eating habits and the standard American diet itself both need an overhaul. In this article, I’ll cover some of what’s wrong with the Standard American Diet, why this is problematic, and what we as healthcare providers can do to help reduce the incidence of disease and promote well-being among our patients.
The problem
A 2010 study that analyzed data from 16,338 Americans ages two and older revealed that the majority of people surveyed were not meeting federal dietary guidelines for micronutrient-rich food groups. Specifically, the majority of Americans surveyed did not meet recommendations in multiple areas, including total fruits, whole fruits, total vegetables, dark green vegetables, orange vegetables, legumes, starchy vegetables, other vegetables, whole grains, and more. [2] In fact, the only categories where the majority of Americans met the federal recommendations were the “total grains” category and the “meat and beans” category. The study also demonstrated that Americans were consuming too much of their calories from solid fats, added sugars, and alcoholic beverages.
To summarize, the average American appears to be eating too many calorie-dense foods and not enough nutrient-dense foods.
Why this is so problematic
This standard American diet is problematic when we consider the physical health of Americans. If Americans are consuming a diet that is highly correlated with disease, our own health is impaired and we also bequeath a legacy of disease to our children, the future generation. Many attributes of the standard American diet, including nutrient-sparse foods (such as those containing concentrated sugar and refined flours), low fiber intake, high dietary consumption of red meat, and an imbalance of omega-6 to omega-3 fatty acids, all contribute to increased risk for cancer and other chronic disease. [3] If a decline in healthspan and longevity weren’t enough, increased risk for disease will inevitably fuel the rising cost of healthcare in our nation.
Steps toward a potential solution
It should be clear that we have a very big problem on our hands and that we need to be proactive, innovative, and practical in our quest to find a cost-effective, functional solution. Now, I want to make it clear that it isn’t my intention to pretend that the solution to the problem I’ve just presented is simple or that I believe I have all of the answers. My goal here is to present the problem and to present three small steps that we as healthcare providers can take to do our parts in addressing this monstrous problem.
1. Ask telling questions
The first thing that we can do as healthcare providers is to ask telling questions. People love to talk about themselves, and when we meet with our patients, we can ask questions surrounding diet that encourage them to be open and honest. For example, instead of asking “What is your diet like?” we can ask “What are some of your family’s favorite meals or traditions?” or “Who does the grocery shopping (or cooks) in your home?” These types of questions feel more like a conversation and they invite the patient to be open and honest about their reality, as opposed to making them feel as though they need to prove to you that they’re on their best behavior.
2. Keep instructions simple
As humans, we like things to be simplified. Our patients are no different. While these things may work for the highly motivated patient, the average patient doesn’t do well when you ask them to do something complicated or time-consuming like counting calories using a food-tracking app. I’ve found that keeping instructions clear and simple (e.g. Make sure that you are eating at least 3 different colors of fruits or vegetables at each meal) makes the greatest impact with the average patient. Even small changes can lead to incredible shifts in our patients’ well-being.
You may find it beneficial to make additional recommendations with your patients as indicated, such as recommending a multivitamin or even IV nutrient therapy in the future, but for the patient eating the standard American diet, I believe the best place to start is with small adjustments toward a more health-producing diet.
3. Encourage patients to cook at home
My final tip is to encourage your patients to cook at home. Research has made it clear: “Cooking dinner frequently at home is associated with consumption of a healthier diet whether or not one is trying to lose weight.” [4] In addition to potentially enhancing health by promoting more family time, cooking at home can improve our patients’ physical health.
Summary
The standard American diet has been associated with increased disease risk and rising healthcare costs. As providers, we can be a part of the solution by asking telling questions in order to encourage our patients to converse candidly with us about their eating habits, keeping our instructions to our patients simple, and encouraging our patients to cook at home.
[1] Centers for Disease Control and Prevention. Vital Signs: Where's the Sodium? Available at: http://www.cdc.gov/VitalSigns/pdf/2012-02-vitalsigns.pdf - PDF.
[2] Krebs-Smith, S. M., Guenther, P. M., Subar, A. F., Kirkpatrick, S. I., & Dodd, K. W. (2010). Americans do not meet federal dietary recommendations. The Journal of nutrition, 140(10), 1832–1838. https://doi.org/10.3945/jn.110.124826
[3] Donaldson M. S. (2004). Nutrition and cancer: a review of the evidence for an anti-cancer diet. Nutrition journal, 3, 19. https://doi.org/10.1186/1475-2891-3-19
[4] Wolfson, J. A., & Bleich, S. N. (2015). Is cooking at home associated with better diet quality or weight-loss intention?. Public health nutrition, 18(8), 1397–1406. https://doi.org/10.1017/S1368980014001943