A Healthier Diet for America

A Yale School of Public Health Professor is Appointed to the Nation’s Top Dietary Panel for the Second Time.

With his appointment to the 2015 Dietary Guidelines Advisory Committee, Yale School of Public Health Professor Rafael Pérez-Escamilla will work over the coming year with 14 other committee members to formulate recommendations and rationale for the eighth edition of the Dietary Guidelines for Americans. He will be one of the four members on the Science Review Subcommittee that will steer the work of the whole committee. The guidelines are the foundation of the nation’s food and nutrition policies. Pérez-Escamilla, Ph.D., is a professor of epidemiology and public health and is an internationally recognized scholar in the area of community nutrition for his work on pregnancy and lactation, food security, obesity, diabetes and food safety. He has expertise with Hispanic and other low-income Americans, as well as populations in low- and middle-income countries. Pérez-Escamilla, who also serves as director of the Office of Public Health Practice at YSPH, served as a member of the 2010 Dietary Guidelines Advisory Committee. This is his second appointment to the national committee, which is a highly unusual honor.

What concerns you most about America’s dietary habits?

RP-E: First, I am very concerned that we are still very far from meeting the recommended consumption of healthy foods that are naturally nutrient dense (such as vegetables, fruits, fish and whole grain products). Secondly, we continue to consume excessive amounts of calories and foods that are rich in unhealthy fats, refined sugars and salt (such as junk food, pastries and sugar-sweetened beverages).

When and how did this problem start?

RP-E: If we use the obesity epidemic as a marker of serious deterioration of lifestyle choices, including diet and physical activity, we can trace the explosion of the problem back to the 1970s. This has been attributed to the emergence of highly obesogenic environments in our society where the easy choices became to consume excessive amounts of calories and to become highly sedentary.

What’s likely to happen with this problem in the coming years?

RP-E: Individual lifestyle choices are heavily influenced by the environments in which people are born, grow, go to school, work and age. And the quality of these environments is in turn affected by social, economic, education, health and agricultural policies, among others. Dietary habits are also strongly influenced by the marketing practices of the food industry. And, of course, by the social position, cultural preferences and the level of health and nutrition literacy of individuals. Unless we design better policies and programs that take into account and properly address all the key spheres of influence on the individual’s dietary choices we won’t be able to change the dire situation of America’s diet.

Is the obesity problem in America likely to change in the coming decade, for better or worse?

RP-E: I believe that obesity levels are going to drop because of the strong social demand that has developed in recent years for improved access to healthier foods and opportunities for physical activity in communities around the country. Also because of the discovery of how important it is to start obesity prevention efforts as early in life as possible (even before mom gets pregnant) and the interest among key stakeholders to translate this fundamental knowledge, the so-called maternal-child life cycle approach to obesity prevention, into concrete actions. However, for this to happen it is crucial that the political leadership provided by key public figures, such as First Lady Michelle Obama, continues in the years to come. Also key to this success will be the proper allocation of funding for research studies to better understand how to work at the different spheres of influence that affect individual’s food and physical activity choices to design better food and nutrition policies and to improve the environments needed for these policies to actually translate into access to healthy diets in neighborhoods, schools and households so that the selection of healthy lifestyles becomes the easy choice for all.

Do Americans, generally speaking, eat too much?

RP-E: Yes, the great majority of Americans consume diets that far exceed their caloric needs including pregnant women and very young children, which is a real public health catastrophe. This has been attributed to the widespread availability of cheap, highly calorie dense processed foods and sugar-sweetened beverages contained in products presented in exceedingly large portion sizes.

You served on the advisory committee in 2010 and helped shape a number of recommendations. What do you see as that panel’s most significant accomplishment?

RP-E: The committee’s report for the first time included a chapter on how to translate the vast amount of scientific knowledge on what constitutes a healthy dietary pattern into multi-level actions. This approach could help strengthen the food systems and access for all Americans while respecting their cultural culinary preferences and irrespective of their social position and age. Also, it was the first Dietary Guidelines report based on a rigorous systematic review methodology using the USDA Nutrition Evidence Library. For me, being part of the first group of nutrition scientists that started populating this magnificent electronic library feels like having been part of the Apollo mission that landed on the moon for the first time!

What do you see as the most pressing challenge worldwide for the Dietary Guidelines in the 21st century?

RP-E: A huge challenge that the world is facing now is that if everyone decided to follow the Dietary Guidelines recommendations, say for fish, we would deplete the ocean in a relatively short period of time. Aquaculture or fish farming has become an alternative, but oftentimes these operations cause damage to diverse ecosystems. Likewise, there isn’t enough fresh produce grown globally through sustainable practices to allow all individuals to meet the recommended daily intakes. The imperative need to understand how to improve the ecological sustainability of the global food systems that need to be in place to allow all individuals to follow the Dietary Guidelines has become one of the most important and complex global challenge for the 21st century.

Can you briefly describe the committee’s mandate?

RP-E: The specific mandate from Congress is to review the 2010 Dietary Guidelines and determine if revisions are needed and in which areas. In other words, Congress mandates the committee to ask itself: Is there any new knowledge that has been generated since the last Dietary Guidelines were issued that Americans need to know about to improve their health? The Dietary Guidelines are the basis for all federal food and nutrition policies so I take this mandate extremely seriously.

Do you have a personal goal for what you would like to see accomplished?

RP-E: My main goal is to be a productive committee member who contributes to the development of the best guidelines ever based upon a transparent evidence-based process.

How directly does the panel’s recommendations affect health?

RP-E: The Dietary Guidelines are based on what we know about the impact of different foods and dietary patterns on human health outcomes. So by definition the degree of adherence to the Dietary Guidelines by Americans has a profound influence on public health. The key question then becomes: What can we all do as a country so that adhering to the Dietary Guidelines becomes the easiest choice and not the most difficult as is now the case in the environments where most Americans live, go to school and work?

How do Americans compare with their peers in other countries in terms of diet and nutrition?

RP-E: Americans tend to follow some of the most unhealthy dietary patterns ever documented among developed nations. Compared to many Western European countries, we spend much less time cooking, we eat outside much more, we consume much more processed foods, we consume much larger portion sizes of foods and meals, we follow dietary patterns that are much higher in calories, sugar and salt and we consume very low amounts and variety of fruits, vegetables, whole grain products, fish and other healthy foods. As a result, our obesity and related chronic diseases rates are much higher in the United States.

What dietary trends make you most optimistic about the future?

RP-E: I strongly believe that the spread of grass roots movements across the country seeking to establish sustainable local food systems that provide access to fresh, untainted food products year round is a sign that the tide may be turning (the so-called ‘food justice’ movement). These changes in public opinion and civic engagement in food security issues has the potential to become a very powerful force that can help shape much healthier and fairer food systems from the local to the global level.