Nutrition Literacy in America

hands holding Colorful vegetables

By Christian Maino Vieytes, Doctoral Student, Division of Nutritional Sciences, University of Illinois at Urbana-Champaign.

Nutrition Literacy

The rise in overweight and obese adults has led to devastating increases in rates of heart disease, stroke, and cancer. These worrying statistics are the source of much anguish for public health professionals who worry about nutrition literacy remaining low in the United States.

Nutrition literacy is defined as “the degree to which people have the capacity to obtain, process and understand basic nutrition information” (1). The importance of nutrition literacy stems from its ability to inform and modify eating practices across different populations. Higher nutrition literacy, which can be measured objectively using surveys formulated by academic researchers, has been associated with the consumption of a higher-quality diet, rich in fruits and vegetables (2). Furthermore, in general, lower health literacy has been shown to negatively predict several indicators of health status, such as significantly more hospitalizations and greater use of emergency care services among those with low nutrition literacy (3).

Given that nutrition literacy is an integral part of overall health, the need to educate Americans on nutrition-related issues has become an authoritative goal to combat the rise in chronic disease and minimize adverse effects on our health care system.

The Evolving Nature of Dietary Knowledge

As with any other science, nutritional science is subject to change and evolution. A likely explanation for why nutritional literacy remains low is confusion and public mistrust stemming from the evolving-nature of this science (4). Dietary fat, for instance, was once vilified. The consensus amongst researchers has since shifted, and the source of the fat should not be overlooked (5). The recommendation is now that foods rich in monounsaturated fats, such as avocados, should be consumed in place of foods high in saturated fats, such as red meat and processed meats. Additionally, there has been a movement in government policy and academics for changing nutrition recommendations to be food-based as opposed to nutrient-based (6,7).

The Dietary Guidelines for Americans

The main way food policy is communicated to the public is through the Dietary Guidelines for Americans, whose first iteration was realized in 1980 with the release of Nutrition and Your Health: Dietary Guidelines for Americans (7). The goal of these and the current guidelines is to provide Americans with a resource for making healthier food choices and inform food policy choices made at the local, state, and federal government levels (8). Forty years have passed since the inception of these national guidelines. The program is now ready to introduce the ninth iteration in its set of recommendations in the 2020-2025 Dietary Guidelines for Americans.

Despite the measures taken by the federal government to modify nutrition policy in the United States through the Dietary Guidelines for Americans program, nutrition literacy has remained low. Other influential factors, such as a lack of diet and lifestyle education in public school curricula and the lack of emphasis on nutrition education for medical doctors, are notable.

The School

A significant reason why we lack the arsenal of nutrition knowledge necessary for making healthy choices is that we, simply, were never taught this knowledge. Dietary habits are formed early in childhood. This fact, alone, underscores the need to develop better educational programs for children early on in their elementary education.

The research has demonstrated that habits, along with nutrition-related diseases, such as type 2 diabetes, acquired during a child’s formative years track with them into adulthood (9). However, many barriers preclude teachers from delivering nutrition education in the classroom. Primarily, we find that because this type of knowledge is not found on standardized testing, it is not as likely to be emphasized in curricula. Nevertheless, several lines of research studying the effects of nutrition education programs on children’s’ dietary consumption have shown that they are, indeed, effective (9).

The Physician

Many Americans obtain health knowledge directly from their primary care or specialist physicians. Yet, most medical doctors receive little to no training in matters of nutrition. Levels of nutrition literacy amongst physicians also remain low (10,11). This is a sizable concern, given that diet plays a massive role in preventing chronic illnesses such as heart disease (11,12).

Bolstering Nutrition Literacy

Despite the forces that work against our acquisition of nutrition knowledge, the beauty of learning is that it only takes a little motivation and a list of resources to read and learn from. With the advent of the internet, there have been a multitude of sources to obtain nutrition education. Given the rise of fad diets and erroneous sources, it is recommended that only authoritative sources be used when researching matters of nutrition.  This means obtaining information and data from government or non-governmental organizations. Several links to reputable organizations and websites will be provided below.

Nutrition knowledge is  powerful! Empowering individuals with this knowledge is critically important for preventing illness and slowing the chronic disease epidemic we face in our nation. Yet, it is never too late to become educated, increase your nutrition literacy, take control of your health, and pass that knowledge on to your peers and the generations to come.

Resources

The Academy of Nutrition and Dietetics

The Food and Drug Administration

nutrition.gov

The Physicians Committee For Responsible Medicine

Healthline

SNAP-ed

The World Health Organization

Harvard T.H. Chan School of Public Health

The American Heart Association

The Food Literacy Center Blog

 

References

  1. Zoellner J, Connell C, Bounds W, Crook L, Yadrick K. Nutrition literacy status and preferred nutrition communication channels among adults in the Lower Mississippi Delta. Prev Chronic Dis. 2009 Oct;6(4):A128.
  2. Taylor MK, Sullivan DK, Ellerbeck EF, Gajewski BJ, Gibbs HD. Nutrition literacy predicts adherence to healthy/unhealthy diet patterns in adults with a nutrition-related chronic condition. Public Health Nutr. 2019;22(12):2157–69.
  3. Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011 Jul 19;155(2):97–107.
  4. Garza C, Stover PJ, Ohlhorst SD, Field MS, Steinbrook R, Rowe S, et al. Best practices in nutrition science to earn and keep the public’s trust. Am J Clin Nutr. 2019 01;109(1):225–43.
  5. Liu AG, Ford NA, Hu FB, Zelman KM, Mozaffarian D, Kris-Etherton PM. A healthy approach to dietary fats: understanding the science and taking action to reduce consumer confusion. Nutr J. 2017 Aug 30;16(1):53.
  6. Hu FB. Dietary pattern analysis: a new direction in nutritional epidemiology. Curr Opin Lipidol. 2002 Feb;13(1):3–9.
  7. Mozaffarian D, Rosenberg I, Uauy R. History of modern nutrition science-implications for current research, dietary guidelines, and food policy. BMJ. 2018 13;361:k2392.
  8. Watts ML, Hager MH, Toner CD, Weber JA. The art of translating nutritional science into dietary guidance: history and evolution of the Dietary Guidelines for Americans: Nutrition Reviews©, Vol. 69, No. 7. Nutr Rev. 2011 Jul;69(7):404–12.
  9. Cotton W, Dudley D, Peralta L, Werkhoven T. The effect of teacher-delivered nutrition education programs on elementary-aged students: An updated systematic review and meta-analysis. Prev Med Rep. 2020 Dec;20:101178.
  10. Kiraly LN, McClave SA, Neel D, Evans DC, Martindale RG, Hurt RT. Physician Nutrition Education. Nutr Clin Pract. 2014 Jun;29(3):332–7.
  11. Aggarwal M, Devries S, Freeman AM, Ostfeld R, Gaggin H, Taub P, et al. The Deficit of Nutrition Education of Physicians. Am J Med. 2018;131(4):339–45.
  12. Aspry KE, Van Horn L, Carson JAS, Wylie-Rosett J, Kushner RF, Lichtenstein AH, et al. Medical Nutrition Education, Training, and Competencies to Advance Guideline-Based Diet Counseling by Physicians: A Science Advisory From the American Heart Association. Circulation [Internet]. 2018 Jun 5 [cited 2020 Sep 9];137(23). Available from: https://www.ahajournals.org/doi/10.1161/CIR.0000000000000563 

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