More actions needed to improve nutrition in US, say experts and lawmakers

WASHINGTON – With nearly a third of federal spending going on health care, what is most of the money – 80% – spent on? Treatment of preventable diseases, many of which are caused by unhealthy diets, said Sen. Cory Booker (DN.J.), chair of the Senate Agriculture, Nutrition and Forestry Subcommittee on Food and nutrition, special crops, organics and research. Tuesday.

“Currently in the United States, half of the American population is pre-diabetic or has type 2 diabetes,” Booker continued. “In 1960, about 3% of the American population was obese. Today, over 40% of Americans are obese and over 70% of Americans are either obese or overweight.”

Booker’s remarks launched a hearing on nutritional status in the United States, he noted that although the country has made progress in the fight against hunger, “we are now facing this second food crisis – a crisis of nutrition insecurity where too many Americans are overfed but under. -fed and see these staggering rates of disease and premature death. ” Although the United States is the richest country in the world, “we have created a food system that relentlessly encourages overconsumption of empty calories, literally making us sick and forcing us to spend an ever increasing amount of our money. our taxpayers … treat diet-related illnesses such as type 2 diabetes, heart disease, stroke, certain types of cancer and chronic kidney disease. “

One potential solution to this problem is better nutrition education for physicians, according to Dariush Mozaffarian, MD, cardiologist and dean of the Friedman School of Nutrition Science & Policy at Tufts University in Boston. “The vast majority of doctors say in surveys that they recognize that nutrition is so crucial for their patients, that they want to learn more and that they are not learning enough in their training,” he said. declared during the hearing. “The simple way to fix this is to change the tests. We need to change the US medical licensing exam, specialty board tests, and continuing medical education tests that every doctor takes, for the leading cause of ill health in our country. Shouldn’t all tests have 5% or 8% nutrition questions? We’re changing the test, we’re going to change medical education overnight. “

Including more nutritional questions in clearance tests and board reviews would go a long way in improving nutrition education for physicians, said Dariush Mozaffarian, MD, of Tufts University. (Photo courtesy of C-SPAN Live)

Mozaffarian listed three other ways to make nutrition a priority:

  • Medically tailored meal. “We need to have Medicare and Medicaid, test, implement and scale medically appropriate meals,” Mozaffarian said. “These are [home-delivered], nutritionally adapted meals for the sickest patients with serious chronic diseases such as kidney failure, heart failure, poorly controlled diabetes and cancer. Research has shown that giving medically appropriate meals to these sick patients reduces hospitalizations, reduces [emergency department] visits, reduces nursing home visits and even accounting for the cost of the program, in fact saves money – in a single analysis, up to $ 10,000 per patient per year.
  • Write prescriptions for people with food-sensitive illnesses who can still shop and cook. “A doctor should be able to write a prescription for fruits, vegetables, beans or other healthy foods that are partially or fully covered by insurance,” he said. “Prescribing appears, by all the evidence, to be at least as cost effective as other treatments such as cholesterol lowering drugs for the primary prevention of heart attacks.”
  • Better reimbursement for dietitians. “In Medicare, dietitians can only be reimbursed for counseling patients for a very small and limited set of conditions like diabetes or kidney disease, but not for many, many other major diet-related conditions like overweight or obesity, high blood pressure, heart disease, stroke or cancer, ”Mozaffarian said.“ In a cardiology clinic, I can be reimbursed for having a genetic counselor on my team, but I cannot be reimbursed for having a nutritionist on my team. It is time to fix this problem. “

Senior committee member Senator Mike Braun (R-Ind.) Asked how important it is for the American Medical Association (AMA) to take the lead on this issue, “rather than trying to forcing solutions through government – what’s always a little trickier … How important is it that WADA gets involved in this area? “

Patrick Stover, PhD, dean and vice chancellor for agriculture and life sciences at Texas A&M University at College Station, did not respond directly, noting that when he was president of the American Society for Nutrition , “We’ve spent a lot of time trying to focus on bringing more nutrition into medical education. This is a huge challenge because every professional company wants more of their type of education in the medical degree. At Texas A&M, we encourage combined nursing and diet programs. It is the nurses who are the frontline health workers who see every patient, especially in our disadvantaged communities. We need to make sure these frontline workers get this nutrition education because there just aren’t enough dietitians in these health facilities to educate about nutrition. “

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Although the United States has made progress in reducing hunger, “we are now facing this second crisis – that of nutritional insecurity,” said Senator Cory Booker (DN.J.). (Photo courtesy of C-SPAN Live)

Another piece of the puzzle is food marketing and advertising, Booker said. “The majority of our food system is now controlled by a handful of large multinational corporations. These food companies carefully format, formulate and market ultra-processed, nutrient-poor and addictive foods, which now represent two-thirds of calories. in the USA. And these companies want us to believe that the resulting diet-related illnesses, such as obesity and diabetes, are somehow a moral failure, whether they represent unwillingness or a failure to do enough. exercise. It’s just a lie. “

Instead, Booker said, “it’s the failure of our collective policy because the federal government is currently subsidizing easy access to foods that are high in calories but have minimal nutritional value, while at the same time, too much. communities – rural and urban – do not have access to the healthy food they need to thrive. ” Additionally, although federal guidelines suggest that Americans’ diets should consist largely of fruits and vegetables, “currently less than 2% of our federal farm subsidies in the United States go to these healthy foods.”

Much of the marketing of unhealthy food is directed to communities of color, said Angela Odoms-Young, PhD, director of the Community Food and Nutrition Education program and associate professor of nutritional sciences at Cornell University at Ithaca, New York. A 2019 report from the Rudd Center for Food Policy and Obesity at the University of Connecticut found that “23 restaurants spent $ 99 million to advertise on television that primarily targets African Americans,” he said. she declared. “Compared to white preschoolers, black preschoolers saw about 72% more fast food ads. If you look at teens, they saw around 77% more fast food ads. . “

“This has serious implications when you look at food preferences in eating behaviors,” Odoms-Young continued. “Several studies have shown that immediately after seeing these advertisements, they have a craving for unhealthy food, junk food and fast food. And if you look at black, indigenous and Latin communities, where you have more of this food available , you can actually act on that marketing. “

Booker said he and Braun introduced a bill last week to convene a White House conference on food, nutrition, hunger and health, similar to the one called just over 50 years ago. One witness who liked the idea was Donald Warne, MD, MPH, director of the Indians into Medicine program at the University of North Dakota at Grand Forks. “According to the CDC, 48% of the Native American and Native Alaskan population over the age of 18 is obese, compared to 30% of the non-Hispanic white population,” Warne said, adding he was originally from the reservation. Indian from Pine Ridge in the south of the country. Dakota, where the nearest supermarket is 90 miles in Rapid City. “As a result, many of my family face significant barriers to accessing healthy food, and many of them suffer from diabetes and heart disease.”

In addition to the White House conference, “we also need a well-coordinated comprehensive political approach and we need to understand the nuances of tribal engagement in these areas,” Warne said. “Ideally, we will include stakeholders with lived experience in these important discussions. “

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    Joyce Frieden oversees the coverage of MedPage Today in Washington, including articles about Congress, the White House, the Supreme Court, health professional associations and federal agencies. She has 35 years of experience in health policy. To follow



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