Reflecting the fact that more than one-third of U.S. children and more than two-thirds of adults are overweight or obese, the recently released Dietary Guidelines for Americans, 2010 emphasize the need for Americans to eat a healthier diet and increase their physical activity. But AAFP member and weight management expert Michelle May, M.D., of Phoenix, wonders how many family physicians and/or their patients will actually read the updated 112-page guidelines document.
"The dietary guidelines do a good job of laying out what the general recommendations are, but in its current format(www.cnpp.usda.gov), (the guidelines document is) not going to be helpful to the majority of patients," says May. "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."
"The family physician's role is helping patients identify a couple of the most relevant steps they can work on in relation to the recommendations," she adds.
Fortunately, the report's four-page executive summary(www.cnpp.usda.gov) is far more digestible and should make that task easier for busy family physicians.
In addition to nearly two dozen recommendations for the general public, the new Dietary Guidelines for Americans, 2010 make six recommendations for the following specific subpopulations.
For women or adolescent girls who are pregnant or breastfeeding
- consume 8-12 ounces of seafood per week from a variety of seafood types;
- white, or albacore, tuna should be limited to 6 ounces per week because of its high methyl mercury content, and tilefish, shark, swordfish and king mackerel should be completely avoided; and
- pregnant women should take an iron supplement, as recommended by an obstetrician or other health care provider.
For women or adolescent girls who could become pregnant
- choose foods that supply heme iron -- which is more readily absorbed by the body -- additional iron sources, and enhancers of iron absorption, such as vitamin C-rich foods; and
- consume 400 mcg per day of synthetic folic acid (from fortified foods and/or supplements) in addition to food forms of folate from a varied diet.
For individuals ages 50 years and older
- consume foods fortified with vitamin B12, such as cereals or dietary supplements.
According to the summary, the guidelines cover 23 key recommendations for the general population, including
- 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 percent 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
- only consume alcohol in moderation -- a maximum of one drink per day for women and two drinks per day for men if alcohol is consumed.
According to May, the guidelines' overall approach -- encourage Americans to eat a healthier diet and be more physically active -- is in line with the Academy's Americans In Motion -- Healthy Interventions, or AIM-HI, initiative, which focuses on improving health by addressing physical activity, nutrition and emotional well-being.
However, the updated guidelines, which were jointly developed by the U.S. Department of Agriculture 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," says May, adding that the majority of people who struggle with weight issues eat mindlessly or for emotional reasons.
American Family Physician's new feature, AFP By Topic, has clinical and patient-friendly content family physicians can use (some content available to members and paid subscribers only) to help them manage patients with obesity.
Topics covered include office-based management strategies, counseling overweight and obese patients about physical activity, the use of dietary supplements in weight loss, and evaluating obesity and cardiovascular risk factors in children and adolescents.
Patient education topics range from gaining and maintaining a healthy life balance to practical weight loss tips.
"They're not making the connection between how they're using food and its effect on their health and body weight," she says. "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."
Ideally, says May, family physicians will consider nutrition and physical activity to be part of their prescription or treatment plan in nearly every patient encounter, whether it be for a physical exam or a follow-up visit for a chronic disease.
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," says 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.
"We have to figure out a way to get people to do what the guidelines say, and I think family physicians can really make an impact if they choose to."