# Presentation: 682630

## INTRODUCING:The Year 2000Dietary Guidelines for Americans 

**“****What are the**
**Dietary Guidelines for Americans?”**

**Notes:**
What do you think of when you hear “dietary guidelines?”  Shortly before the latest edition was published, USDA’s Center for Nutrition Policy and Promotion (CNPP) did some focus groups around the country which asked that question.

##  “I don’t know if the average American knows what ‘dietary guidelines’ mean.” (health professional) “People think ‘dietary guidelines’ are for someone who is sick, not them.” (health professional)

**Notes:**
Few consumers had ever heard of the Dietary Guidelines.  And health professionals who were asked about consumer understanding of the guidelines recognized this. They did not think that consumers realize that the Guidelines are meant for them:  “I don’t know if the average American knows what dietary guidelines mean.”  “People think dietary guidelines are for someone who is sick, not them.”

Today, I hope to explain what the year 2000 the Dietary Guidelines are and how some of the information and recommendations have changed since 1995.

## What are the Dietary Guidelines for Americans?

- 	They are brief science-based statements and text published by the Federal government that provide advice for healthy Americans age 2 years and over about food choices and physical activity to promote health and prevent disease.

**Notes:**
To begin to answer this question, this slide gives a brief definition of what the Dietary Guidelines are.  “The Dietary Guidelines are brief science-based statements and accompanying text published by the federal government that provide advice for healthy Americans age 2 years and over about food choices and physical activity to promote health and prevent disease.”

## The Dietary Guidelines are:

- Mandated by law
- Published every 5 years
- Based on the preponderance of scientific evidence
- Cornerstone of Federal nutrition policy
- Basis for nutrition education/promotion activities

**Notes:**
The Dietary Guidelines are mandated by law.  The National Nutrition Monitoring and Related Research Act of 1990 requires the Secretaries of USDA and HHS to publish jointly every 5 years a report that must contain nutritional and dietary information and guidelines for the general public.  It must be based on the preponderance of scientific and medical knowledge current at the time of publication.

In addition to providing general educational information for the public, the Dietary Guidelines also serve as the cornerstone of Federal nutrition policy and nutrition education/promotion activities.  For example, lunches served as part of the National School Lunch Program must comply with the Dietary Guidelines.

##    1980         1985          1990          1995

**Notes:**
Every 5 years since 1980, the U.S. Department of Agriculture (USDA) and the Department of Health and Human Services (HHS) have jointly published Nutrition and Your Health: Dietary Guidelines for Americans.  These are the covers of the 4 previous editions from 1980, 1985, 1990, and 1995.

## How are the Guidelines revised?

- Advisory Committee appointed to review Guidelines -- through an open process
- Committee report presented to USDA and DHHS
- USDA and DHHS review report and public comments
- USDA and DHHS publish revised Guidelines

**Notes:**
And how are the revisions to the Dietary Guidelines made?  Beginning with the 1985 edition, USDA and DHHS appointed a Dietary Guidelines Advisory Committee of prominent experts in nutrition and health to review the scientific and medical knowledge current at the time and recommend to the Secretaries of USDA and DHHS any revisions to the previous Guidelines that they felt were warranted.  The Committee operates through an open, public process, and produces a report of its recommendations and rationale for the Secretaries of USDA and DHHS.  The Departments then review the Committee recommendations and publish the revised Guidelines.

## 2000 Dietary Guidelines Advisory Committee

- Cutberto Garza, MD, PhD (chair)
- Suzanne Murphy, PhD, RD
-     (vice-chair)
- Richard Deckelbaum, MD
- Johanna Dwyer, DSc, RD
- Scott Grundy, MD, PhD

- Rachel Johnson, PhD, MPH, RD
- Shiriki Kumanyika, PhD
- Alice Lichtenstein, DSc
- Meir Stampfer, MD, DrPH
- Lesley Fels Tinker, PhD, RD
- Roland Weinsier, MD, DrPH

**Notes:**
This slide lists the members of the 11-member Advisory Committee for the 2000 Guidelines that met over the course of a year and a half to review the scientific evidence and develop their recommendations.  They held four public meetings, accepted oral and written testimony from the public, and put together a report that was delivered to the Secretaries of USDA and HHS.

**Notes:**
The latest edition of the Dietary Guidelines was released on May 27, 2000, by  the President.  The guidelines were then discussed by Secretaries of Agriculture and Health and Human Services, at the National Nutrition Summit in Washington, DC, on May 30, 2000.

The updated guidelines emphasize food choices in the context of the Food Guide Pyramid and stress physical activity and healthy weight maintenance.  These Guidelines were designed to be more user-friendly and actionable, and to provide more specific advice on food choices than previous editions.

## Slide 10

**Notes:**
The 5th edition contains 10 guidelines.  To help organize the Guidelines and make them easier to remember, they were grouped under 3 themes:  Aim for Fitness, Build a Healthy Base, and Choose Sensibly.  The result is an easy-to-follow message – the ABC’s for Good Health.

**Notes:**
This slide shows the inside front cover of the Guidelines bulletin, listing all ten guidelines.

## Aim for Fitness

- Aim for a healthy weight
- Be physically active each day

**Notes:**
The first group, “Aim for Fitness,” includes two guidelines that were previously combined as one.  “Aim for a healthy weight” and “Be physically active each day” were derived from the 1995 guideline “Balance the foods you eat with physical activity–maintain or improve your weight.”

## Build a Healthy Base

- Let the Pyramid guide your food 	choices
- Choose a variety of grains daily, 	especially whole grains
- Choose a variety of fruits and 		vegetables daily
- Keep food safe to eat

**Notes:**
The second group, “Build a Healthy Base,” includes 4 guidelines that build the foundation for a healthy diet, starting with using the Food Guide Pyramid as a guide for food choices.  The second guideline in this group suggests choosing a variety of grains daily, and emphasizes whole grains.  Next, choosing a variety of fruits and vegetables is also recommended.  Lastly, a new guideline on food safety emphasizes keeping foods safe to eat. 

## Choose Sensibly

- Choose a diet that is low in 		saturated fat and cholesterol and 	moderate in total fat
- Choose beverages and foods to 	moderate your intake of sugars
- Choose and prepare foods with less salt
- If you drink alcoholic beverages, do so in moderation

**Notes:**
The third group, “Choose Sensibly,” includes 4 guidelines that will help individuals make the overall best choices for optimal  health, including guidance on fat, sugar, salt, and alcohol.  These guidelines are choose a diet that is low in saturated fat and cholesterol and moderate in total fat; choose beverages and foods to moderate your intake of sugars; choose and prepare foods with less salt; and if you drink alcoholic beverages, do so in moderation.

## What’s new in the 2000 edition?

-   New Guidelines
-   Aim, Build, Choose grouping

**Notes:**
As I mentioned earlier, the government has been publishing these Guidelines since 1980.  What’s new about the latest edition?  As you have already seen,  new guidelines have been added.  The previous editions all contained 7 guidelines.  Now we have 10 as a result of splitting two and adding one new topic – food safety.  Also, the “Aim, Build, Choose” grouping scheme was included to help make the guidelines easier to remember. 

_**2000 Guideline**_**Aim for a healthy weight**_ _
- _1995 Guideline_
- Balance the food you eat with physical activity -- Maintain or improve your weight

**Notes:**
In addition, there are changes in each of the guidelines themselves.  I’m going to go through each of the ten guidelines and highlight the major changes.  The first guideline is:  Aim for a Healthy Weight.

This guideline provides information to consumers about evaluating and managing body weight.

## Body Mass Index Chart

**Notes:**
In the new guideline, the term body mass index or BMI, which is a measure of weight in relation to height, is introduced to consumers.  BMI cut-off levels for healthy weight, overweight, and obesity are specified on the “Are you at a healthy weight?” chart.

A BMI in the range of 18.5 to 25 refers to healthy weight, 25 to 30 refers to overweight, and a BMI of 30 or higher refers to obesity.  Advice for healthy and safe weight loss is included in the guideline.  This guideline now also provides more information about choosing sensible portion sizes and evaluating weight.

## Weight-related risk factors for chronic disease

- Personal or family history of heart disease
- Male over 45 or postmenopausal female
- Cigarette smoking
- Sedentary lifestyle
- High blood pressure
- High LDL cholesterol, low HDL cholesterol or high triglycerides
- Diabetes

**Notes:**
Related to evaluating weight, a list of risk factors for chronic disease that may be related to overweight or obesity is included.  These include personal or family history of heart disease, being a male older than 45 or a postmenopausal female, smoking cigarettes, and having a sedentary lifestyle, high blood pressure, high LDL cholesterol, low HDL cholesterol, high triglycerides, or diabetes.  The more of these risk factors a person has, the more they may benefit from weight loss if they are overweight or obese.

## Healthy weight in children

- Encourage physical activity
- Offer grain products; vegetables and fruits; low-fat dairy products; and beans, lean meat, poultry, fish, or nuts
- Offer only small amounts of food high in fat or added sugars
- Set a good example

**Notes:**
The number of overweight U.S. children has risen dramatically in recent years.  To combat this problem, tips for encouraging healthy weight in children are provided in the “Aim for healthy weight” guideline.  These include encouraging children to be physically active; offering children grain products, vegetables and fruits, and low-fat dairy products; as well as offering only small amounts of food high in fat or added sugars.  Parents are encouraged to set a good example for their children by eating healthy foods.

_**2000 Guideline**_**Be physically active each day**_ _
- _1995 Guideline_
- Balance the food you eat with physical activity -- Maintain or improve your weight

**Notes:**
Physical activity was mentioned as part of the 1995 weight guideline.  In the 2000 edition, a separate guideline, “Be Physically Active Each Day,” was included to emphasize its importance. 

## Be physically active each day

- Health benefits of physical activity
- Physical activity recommendations
- 		_Adults_ -- 30 minutes of moderate 		physical activity most, preferably all, 		days of the week
- 		_Children_ -- 60 minutes of moderate 		physical activity daily

**Notes:**
This guideline discusses nutrition and physical activity in the development of obesity.  It also identifies health benefits of physical activity beyond weight management, and provides recommendations for moderate-intensity physical activity for adults and youth.

These recommendations include 30 minutes of moderate physical activity most, preferably all, days of the week for adults; and 60 minutes of moderate physical activity daily for children. 

_**2000 Guideline**_** ****Let the Pyramid guide your food choices**_ _
- _1995 Guideline_
- Eat a variety of foods

**Notes:**
The titles of many of the Guidelines have changed, including the replacement of the guideline “Eat a Variety of Foods” with “Let the Pyramid Guide Your Food Choices.”  This changes was made to provide actionable advice for consumers, encourage nutritional adequacy, and help to avoid over-consumption.

## Food Guide Pyramid

**Notes:**
It also builds on the familiarity of the Food Guide Pyramid, which is now recognized by three-fourths of all Americans.

## Let the Pyramid guide your food choices

- Plant foods as a foundation
- Many healthy eating patterns
- Low-fat foods emphasized
- Soy products included
- Dietary supplements discussion expanded

**Notes:**
In this guideline, there is greater emphasis on plant foods as the foundation for a healthy diet, and alternative healthy eating patterns such as those from different cultural backgrounds, religious beliefs, and vegetarian diets are acknowledged.  Recommendations are made to usually choose lean meats and low-fat dairy products.  Soy products are included as an alternative for meats, and soy-based beverages as a calcium alternative for non-milk drinkers such as those who are lactose intolerant.  In addition, the discussion of dietary supplements is expanded to include herbals and other products.  The guideline notes that the value of many of these products is currently being tested.

## Recommended number of servings

**Recommended number of servings**

**Notes:**
This guideline provides expanded information on how many servings from each of the food groups are needed each day for individuals with different calorie needs.  Children 2-6 years old, many women, and some older adults may need about 1,600 calories, listed in the first column here; older children, teen girls, active women, and most men may need about 2,200 calorie, shown in the middle column; and teen boys and active men may need about 2,800 calories, as shown in the last column.
The servings recommended in each group are based on estimated calorie needs, except for the milk group.  The number of milk group servings recommended is based on age.  Children and teens 9 to 18 and adults over 50 should have 3 servings, others need 2 servings daily.  These recommendations are based on meeting the Dietary Reference Intakes for calcium.

_**2000 Guideline**_** ****Choose a variety of grains daily, especially whole grains**_ _
- _1995 Guideline_
- Choose a diet with plenty of  grain products, vegetables, and fruits

**Notes:**
As I mentioned earlier, the 1995 guideline that recommended choosing a diet with plenty of grain products, vegetables, and fruits was split into two separate guidelines.

Further emphasis on variety was included in both guidelines, because of the substantial differences in nutrient content of different foods within these groups.  And, in the new grain guideline, both whole and enriched grains – which which continue to demonstrate an important role in disease prevention – were emphasized in the title of the guideline, as well as throughout the document.

## Common Whole Grain Foods

-   Brown rice
-   Oatmeal
-   Whole oats
-   Bulgur (cracked
-       wheat)
-   Popcorn

-   Whole rye
-   Graham flour
-   Pearl barley
-   Whole wheat
-   Whole grain corn

**Notes:**
Since many consumers may not know what a whole grain product is, a list of whole grain foods – such as brown rice, oatmeal, whole wheat bread, and popcorn – is included in the guideline.

Eating plenty of whole grains, as part of the healthful eating patterns described by these guidelines, may help protect against chronic disease.  Therefore, eating a variety of these grains is encouraged.

_**2000 Guideline**_** ****Choose a variety of fruits****and vegetables daily**** **_1995 Guideline_** **Choose a diet with plenty of  grain products, vegetables, and fruits

**Notes:**
As with the new grain guideline, the new guideline “Choose a variety of fruits and vegetables daily” continues to emphasize that fruits and vegetables are a key part of the daily diet, and their role in disease prevention and health promotion is again highlighted.

## Eat a variety of fruits and vegetables daily

- Need for variety highlighted
- Recommendation: 2 servings of fruits and 3 of vegetables daily
- Fruit and vegetable sources of vitamins and minerals included

**Notes:**
In this edition, as in previous editions, variety is stressed as an important concept, as no single fruit or vegetable–or food for that matter–can supply all needed nutrients.  The recommendation to eat at least “five a day,”  two fruits and three vegetables, also continues in this new edition.

In addition, fruit and vegetable sources of some vitamins and minerals are again provided for easy, actionable advice for consumers.  In the 2000 edition, the nutrients included are carotenoids, the vitamin A precursor, vitamin C, folate, and potassium.

## 2000 Guideline Keep food safe to eat New Guideline in 2000

**Notes:**
One completely new guideline, “Keep Food Safe to Eat,” is included in the 2000 edition.  This guideline focuses on consumer safe food handling practices, and recognizes food safety as a prerequisite for healthy eating.

## Keep food safe to eat

- Wash hands and food surfaces often.
- Separate foods while storing and
-       preparing.
- Cook foods to a safe temperature.
- Refrigerate perishable foods promptly.
- Follow the label.
- Serve safely.
- When in doubt, throw it out.

**Notes:**
The messages in this new guideline are essentially the same as those used in the Partnership for Food Safety Education’s FightBAC! Campaign.  The guideline targets 7 simple actions that consumers can take when preparing, serving, and storing food.

These are:  wash hands and food surfaces often; separate foods while storing and preparing; cook foods to a safe temperature; refrigerate perishable foods promptly; follow the label; serve safely – meaning keep hot foods hot and cold foods cold; and finally, when in doubt, throw it out.

_**2000 Guideline**_** ****Choose a diet that is low in saturated fat and cholesterol and moderate in total fat**_ _
- _1995 Guideline_
- Choose a diet low in fat, saturated fat, and cholesterol

**Notes:**
The 2000 guideline on fat increases the emphasis on the importance of reducing saturated fat and cholesterol in the diet.  It de-emphasizes reducing total fat, changing the guidance from choosing a diet “low in total fat” to “moderate in total fat.”

This new wording acknowledges the strong scientific evidence that high intakes of saturated fat and cholesterol contribute to the development of coronary heart disease and that the available evidence does not support assigning first priority to a diet low in total fat. 

## Choose a diet that is low in saturated fat and cholesterol and moderate in total fat

- Total fat recommendation: 30% of calories or less
- Descriptions of the different types of fat
- Limits on saturated fat and total fat for various calorie levels
- Comparison of saturated fat content of foods

**Notes:**
Although the wording of the guideline has changed, the amount of total fat recommended by the guideline remains at 30% or less of total calories.

In addition, the new guideline provides more information about types of fats, including trans fatty acids and their relationship to increased risk for coronary heart disease.  The different types of fat and foods that contain these fats are described in a box “Know the different types of fat.”

The guideline also includes additional resources to help consumers make sensible food choices.  These are in boxes titled “What is your upper limit on fat for the calories you consume?” and “A comparison of saturated fat in some foods.”

_**2000 Guideline**_** ****Choose beverages and foods to moderate your intake of sugars**_ _
- _1995 Guideline_
- Choose a diet moderate in sugars

**Notes:**
The wording of the 2000 guideline on sugars was changed to “choose beverages and foods to moderate your intake of sugars.” The guidelines now emphasizes limiting beverages and foods high in added sugars and low in other nutrients as a way to moderate overall intake of sugars.

## Major sources of added sugars

- Soft drinks
- Cakes, cookies, and pies
- Fruitades and drinks such as fruit punch
-  	and lemonade
- Dairy desserts such as ice cream
- Candy

**Notes:**
Information is included in the guideline to help consumers identify foods and beverages that are high in added sugars, and guidance to limit consumption of these is given.  This slide shows a listing provided in the guideline of the top sources of added sugars in the U.S. diet.

_**2000 Guideline**_** ****Choose and prepare foods****with less salt**_ _
- _1995 Guideline_
- Choose a diet moderate in salt and sodium

**Notes:**
The salt/sodium guideline was reworded to be more actionable for consumers and also to bring attention to a major source of salt in the diet–food processing and preparation.  In addition, the sodium terminology was dropped from the title; “salt” is a more familiar term for consumers.

## Choose and prepare foodswith less salt

- Steps that may help keep blood pressure in a healthy range
- Is lowering salt intake safe?
- Salt versus sodium

**Notes:**
There are three new boxes in the salt guideline that provide consumer-friendly advice and tips.  These include “Steps that may help keep blood pressure in a healthy range,” “Is lowering salt intake safe?,” and a comparison of “Salt versus sodium.” 

_**2000 Guideline**_** ****If you drink alcoholic beverages, do so in moderation**
- No change in title from 1995

**Notes:**
The final guideline on alcohol remained unchanged in its title.  

## If you drink alcoholic beverages, do so in moderation

- Adverse effects of excess intake
- Health benefits related to age ranges
- Other ways to reduce heart disease risk
- Who should not drink
- Moderate drinking:  1 per day for women, 2 per day for men

**Notes:**
Text revisions in the alcohol guideline were made for the purpose of emphasizing the adverse effects of excess alcohol intake.  In addition, age ranges were listed for those who may benefit from alcohol consumption.  That is, drinking in moderation may lower the risk for heart disease in men over the age of 45 and women over 55.  Moderate consumption of alcohol provides little, if any, health benefit for younger adults.  Other factors that reduce the risk of heart disease, such as a healthy diet, physical activity, and avoiding smoking, are also mentioned.

In addition, the guideline continues to define groups that should not drink, including children, adolescents, and pregnant women.  Moderate drinking continues to be defined as 1 drink per day for women and 2 drinks per day for men.

**Notes:**
Now that the Dietary Guidelines have been released, what can we do to make Americans aware of these health messages?

## Target audiences for publication

- Policymakers
- Nutrition and health educators
- Physicians and other health professionals
- Trade associations and industry
- Consumers

**Notes:**
There are several target audiences for this publication.  Public and private sector policymakers can use the Guidelines as the basis for dietary guidance materials and programs to enhance nutritional quality of food supplies and provide food assistance.  Nutrition and health educators can use them as a framework for guidance for specific population subgroups.  Physicians and other health professionals can provide dietary recommendations to patients/clients.   Trade associations/industry can use the Guidelines for product development and improvement, as an educational tool, and as part of a marketing plan to increase sales.  And, of course, consumers can use this publication to help select healthy meals for themselves and their families.

## Using the Dietary Guidelines for Americans

- 5-panel fold-out brochure
- Provides basic advice from Guidelines
- Consumer-friendly format

**Notes:**
This leads to a spin-off publication of the Dietary Guidelines – the consumer brochure “Using the Dietary Guidelines for Americans.”  This 5-panel shortened version highlights advice for healthy eating contained in the Guidelines in a consumer-friendly format.

## For Guidelines materials and information:Look on the Center for Nutrition Policy and Promotion website

***www.cnpp.usda.gov***

**Notes:**
This brochure, as well as the full 40-page Dietary Guidelines bulletin, are available to download from the CNPP web site and also are available for sale.  Check the web site for ordering information.

The USDA Center for Nutrition Policy and Promotion plans to continue to develop materials based on the Dietary Guidelines.  As they are developed, they will be posted to the CNPP web site.

## Putting the Guidelines to work

- Goal: Improved consumer health
- Strategies
- Increasing awareness
- Encouraging behavior change

**Notes:**
The Dietary Guidelines have great potential to improve the health and well-being of Americans.  Through increased awareness and adoption of the Guidelines’ advice this goal can be achieved.  In order to do this we need to extend the limited resources of USDA and the Federal government and look for creative ways to reach consumers with Guidelines messages.

## Putting the Guidelines to work

- How?
- Extend Federal resources
- Find creative channels for messages
- Who?
- Industry
- Professional organizations
- Worksites

**Notes:**
There are many ways to support this effort. For example, food companies can tie promotion efforts or products to the guidelines to increase awareness. Professional organizations, the Cooperative Extension Service, schools, and worksites can promote guidelines through their programs and educational materials.  They can also target specific audiences and messages.

*“**This is a great educational tool -- possible to show others to get them to reduce fat intake.” **(consumer)**“This is something that everyone needs --I’d like a copy.”**(consumer)*

**Notes:**
Consumers who have seen prototypes of the Dietary Guidelines bulletin find it to be very useful: “This is a great educational tool – possible to show others to get them to reduce fat intake.”  “This is something that everyone needs – I’d like a copy.”

But, to change dietary behavior of Americans, it is going to be necessary to greatly expand our efforts to reach consumers – using multiple channels with consistent and reinforcing messages.  Helping to improve the diets of Americans will take a concerted effort from everyone: government officials and policymakers, researchers, industry, educators, and healthcare professionals.