“Fixing America’s Eating Habits” in Food Stores

Workman Sitting on a Basket Cutting BreadThe fix is in press this week for our terrible eating habits. In Nature Medicine, Pao-Hwa Lin and Crystal Tyson review a new RCT of interventions in food stores that they believe point the way to “fixing America’s eating habits.” They write:

“Today, more than half of all adults in the USA have one or more diet-related chronic diseases and health conditions, including obesity and diabetes, and the situation is worsening.

“Food manufacturers and retailers can prosper by growing a loyal customer base, doing right by their customers in the way that they manufacture and sell healthy food, and providing tools to support customers’ healthy eating habits.”

A Daunting Challenge

The ambition here is good. But the authors tell us correctly that the challenge is daunting. “Deciphering diet information and translating it into advice for their patients” is so frustrating that clinicians don’t engage in it.

So the idea here is to engage with stakeholders in broader systems that shape the food environment. In the case of the present study, this was food retailers and their dietitians.

Short-Term Changes for a Long-Term Goal

Dylan Steen and colleagues designed their RCT to test dietary interventions delivered in the setting of a supermarket. They collaborated with Kroger and randomized people into three arms – a control group and two strategies for dietary education in stores and on the web:

“Both Strategies 1 and 2 included individualized, in-person, dietitian-led, purchasing data-guided interventions. Strategy 2 also included online tools for shopping, home delivery, selection of healthier purchases, meal planning and healthy recipes.”

For this study, the measure of healthy eating habits was a DASH score for adherence to the DASH diet. When Steen et al combined the two intervention groups, they found that eating habits improved versus the control group after three months. But three months later, after the intervention was over, they could find no effect. Furthermore, they found no effect on measures blood pressure or BMI.

Individual Coaching for Population Health?

Clearly, dietary coaching can be quite helpful for some individuals. Lin and Tyson seem to think that it’s a promising strategy for population health. “The lack of sustained, long-term success up to now should not discourage us from delivering interventions at food retailers,” they write.

But it’s hard to imagine that a wide swath of the population will engage sufficiently to move the needle on dietary health. It could be that more systemic changes are necessary for fixing the eating habits that shape our health. Very likely, we will need to reshape our food systems that in turn shape our dietary habits.

Click here for the study and here for the commentary.

Workman Sitting on a Basket Cutting Bread, lithograph by Vincent van Gogh / WikiArt

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December 6, 2022

2 Responses to ““Fixing America’s Eating Habits” in Food Stores”

  1. December 06, 2022 at 8:38 am, Mary-Jo said:

    Having worked with people who have diseases whereby needing dietary modifications, long-term, to enhance their health, stave off horrible symptoms — things like inborn errors of metabolism, hyperlipidemias, cystic fibrosis, lactose-intolerance, celiac disease, including diabetes — dietary counseling REGULARLY with long-term follow-up is needed. Sometimes, people can master the lifestyle changes after just a few sessions, it becomes their new normal, especially when they feel results Mostly, people need a lot of help, initially and on-going, with shopping, retooling family favorite dishes, recipe/food prep/cooking ideas. Yes, there’s more ultraprocessed foods available today, but there’s still an ample supply of wholesome foods, too. And more good news is that there’s been innovation in foods now on shelves that offer more variety and taste to help people who need to follow health-promoting diets. People have gotten used to, normalized, too-big portion sizes over the past 40 years. Timely dietary counseling combined with getting food manufactures/distributors/ restaurants to return portion sizes back to what they used to be (remember monkey dishes?) would make a big difference in improving diets of people, imho.

  2. December 06, 2022 at 10:20 am, Allen Browne said:

    Yup! Writing “Poison!” On something is not as effective as removing the something from the shelf.

    I like Mary-Jo’s suggestion about portion sizes!

    Food systems should be interested in helping people be healthier and live longer – Living healthier and longer means more consumption and this means selling more food.