Policy Implementation Dietary Guidelines

Dietary Guidelines: Policy Implementation As noted by the Robert Woods Johnson Foundation (RWJF), the dietary guidelines for Americans (last issued in 2015), have tremendous influence upon public policy and how Americans eat, as well as public healthcare. The Dietary Guidelines for Americans issued by the Department of Health and Human Services (HHS) and the Department of Agriculture (USDA) are used in setting the standards for the National School Lunch Program, on which many children are dependent for their main source of nutritional calories for the day at low or reduced cost.

Physicians are influenced by its guidelines, and ordinary Americans are influenced by the guidelines when they make decisions in the grocery store. As noted by the RWJF, a number of significant modifications were made in the most recent 2015 guidelines, including limiting the sugar added to the individual’s diet to no more than 10% of daily calories (Goldman, 2015). It should be noted that this does not apply to fruit and other foods with natural sugars.

The guidelines also removed the previous recommendation to limit cholesterol to 300 mg per day, in line with current evidence-based research and revised the recommendations. Regarding fat, the guidelines now state that instead of limiting fat to a specific percentage of one’s diet, no more than 10% of the individual’s total dietary calories should come from saturated fat (Goldman, 2015). Of course, these dietary recommendations have been quite controversial over the years.

Depending on what particular diet people prefer or recommend (paleo and low-carbohydrate advocates tend to support a more fat-heavy and animal protein-heavy diet, versus vegetarians who are more apt to eschew recommendations to allow for more animal cholesterol in the diet), they are more or less likely to support these new revisions. There are also concerns that business-related lobbying groups, or agricultural producers will influence the dietary recommendations based upon their economic needs and political clout in Washington, versus the genuine physical health requirements of Americans.

With this in mind, it can be useful for advanced practice nurses (APNs) to review the literature that supports or does not support the current guidelines and recommendations. APNs must be aware of the guidelines’ influence upon how school lunches are prepared and even how the labels on foods appear, given that the dietary recommendations are often posted upon prepared and processed foods. Sugar Recommendations Perhaps the least controversial recommendation of the new US Dietary Guidelines is the recommendation to further reduce the individual’s consumption of sugar.

Sugar has long been associated with increased weight and tooth decay. Given that obesity remains a persistent problem for Americans, and for a growing percentage of children at younger and younger ages, reducing sugar to counteract this trend, as well as to lower the risk of diabetes, heart disease, and other problems associated with excessive weight and sugar intake seems wise.

According to the British Medical Journal, “added sugar is directly correlated with risk for metabolic syndrome in adolescents,” even when controlled for total caloric intake (Vreman, et al., 2017, p.2). In other words, when groups of individuals with the relatively identical caloric intakes are compared, persons with higher levels of added sugar are more likely to experience associated medical complications. Additionally, added sugar is associated with higher levels of hypertension and uric acid levels (Vreman, et al., 2017). Sugar-sweetened beverages are likewise associated with excess weight (Vreman, et al., 2017).

In other words, although excessive caloric intake must be avoided to maintain a healthy weight, an excessively high percentage of sugar in the diet is associated with excess weight. Sugar is also associated with foods that are low in nutrition density and high in palatability (such as sugary cakes, cookies, cereals, and beverages) and makes it much easier to assume high levels of calories with minimal satiety, making it difficult to control one’s intake.

The APN can work with patients to suggest other meal and snacking alternatives to reduce sugar intake and also make the patient aware of what foods may have hidden sugars and add up over the course of the day. Nutritional labels can be useful to the patient, particularly if the APN takes the time to educate the nurse in how to read them properly. Revised Cholesterol Recommendations Cholesterol has long been associated with poor health in the public imagination.

But the revised recommendations take into consideration the fact that not all cholesterol is created alike. As noted by Fessler (2015), high-density lipoprotein cholesterol (HDL) protects the patient against LDL [low-density lipoprotein] lesions by “promoting reverse cholesterol transport from vessel walls” and also possesses “anti-inflammatory, antioxidant, antiapoptotic, antiplatelet, vasodilatory, endocrine, and antimicrobial effects” (p.969).

Simply advising patients to reduce cholesterol levels and viewing all cholesterol as dangerous flies in the face of medical research and can encourage people to cut out potentially beneficial fatty products, such as salmon, almond butter and avocado, from diets, even though such fat-containing products are good for the health. The revised recommendations reflect a change in philosophy, versus recommendations based upon earlier studies which had found an elevated risk in heart disease due to dietary consumption of cholesterol-containing foods (Goldman, 2015).

But the relationship of diet and cholesterol is much more complicated. After all, the human body naturally produces cholesterol. Individual responses can vary, as seen in studies of egg consumption in individuals, not all of whom exhibit the expected spike in cholesterol, even after excessive daily intake (Goldman, 2015). There is an indication of increased biosynthesis of cholesterol in overweight versus normal weight persons of cholesterol (Goldman, 2015). Weight, genetics, and other lifestyle factors thus can all impact cholesterol.

Of course, given that professional medical researchers are still struggling to puzzle out the relationship between these different factors, it can be even more confusing for an ordinary layperson to do so with his or her own diet. The APN must make current general guidelines clear to the patient, pinpoint the patient’s personal genetic and lifestyle risk factors, and work to assess the best dietary interventions to ensure optimum health, also taking into consideration the patient’s lifestyle choices and psychology in regards to diet.

Fat Recommendations Just as not all cholesterol is bad cholesterol, yet another confusing yet relevant insight of the new dietary recommendations is that not all fat is created equal. The new dietary recommendations specifically target saturated fat as a problem, versus all fat in general. Fat is a necessary part of the human diet, and has a beneficial role in promoting satiety, as well as is needed to metabolize other macronutrients effectively. Eschewing fat entirely is counterproductive to good nutrition and to weight maintenance.

In fact, according to Nettleton (et al., 2017), even saturated fat has been unfairly demonized.